Does Preoperative Modic Changes Influence the Short-term Fusion Rate of Single Level Transforaminal Lumbar Interbody Fusion?-a Matched-pair Case Control Study

The ability of SPEEK to promote the proliferation and osteogenic differentiation of BMSCs on PEEK surfaces

To investigate the ability of sulfonated polyetheretherketone (SPEEK) to promote the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) and compare the effects of different degrees of sulfonation (DS), SPEEK was made with two different DS. The L-SPEEK group had a lower DS, while the H-SPEEK group had a higher DS. The physicochemical properties of both species were evaluated by scanning electron microscopy (SEM), capitilize Fourier transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TGA), X-ray diffraction (XRD) and differential scanning calorimetry (DSC). Then, proliferation and osteogenic differentiation between the two groups and with pure polyetheretherketone (PEEK) were compared after surface inoculation of bone marrow mesenchymal stem cells (BMSCs). Scanning electron microscopy (SEM) revealed that the surface of the PEEK substrates could be smooth or coarse, and the degree of roughness increased with increasing sulfonation. FTIR spectroscopy showed that both the L-SPEEK and H-SPEEK samples contained sulfonic acid. TGA and XRD revealed that the components in the two groups were the same, but the intensities were different. After BMSC inoculation, a CCK8 assay revealed that the cells proliferated more on the H-SPEEK surface and little on the L-SPEEK surface compared with the PEEK surface. Then, osteogenic differentiation was verified by immunofluorescence staining for OCN and Runx2, which indicated that H-SPEEK had the greatest effect on improving differentiation. The results of alizarin red staining (ARS) and alkaline phosphatase staining (APS) also revealed this trend. Sulfonation can change the microsurface of PEEK, which can improve both BMSC proliferation and osteogenic differentiation.

Do modic changes affect the fusion rate in spinal interbody fusion surgery? A systematic review and network meta-analysis

OBJECTIVE

To compare the fusion rates of spinal interbody fusion in patients with modic changes (MCs).

METHODS

This meta-analysis was registered at PROSPERO, and the project number was CRD42024538023. This network meta-analysis was conducted according to the PRISMA 2020 statement. The PubMed, Embase, Web of Science Core Collection, ClinicalTrials.gov and Cochrane Library databases were searched from inception to March 28, 2024 for potential studies. STATA 13.0 and Review Manager 5.3 were used to perform the meta-analysis.

RESULTS

Seven studies with a total of 1162 patients or segments assigned to four groups according to MCs grade were identified. The fusion rate in the non-modic changes (NMCs) was significantly greater than that in the MCs at the 3-month (p = 0.0001) and 6-month (p = 0.002) follow-ups. No significant difference was detected in the fusion rate at 12-month (p = 0.34) and final follow-ups (p = 0.41). No significant difference was found in cervical fusion (p = 0.88) or transforaminal lumbar interbody fusion (TLIF) (p = 0.51). The fusion rate of NMCs was significantly greater than that of MCs in posterior lumbar interbody fusion (PLIF) (p < 0.00001). No significant differences were identified among the four groups in the overall comparison, cervical fusion or TLIF subgroups. The fusion rate in the NMCs was significantly greater than that in the MCs-2 and MCs-3 in the PLIF.

CONCLUSION

MCs decreased the fusion rate at the 3- and 6-month follow-ups. MCs-2 and MCs-3 decrease the fusion rate in PLIF.

Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody Fusion: The Prevalence, Risk Factors, and Impact on Fusion

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

This study aimed to assess postoperative sclerotic modic changes (MCs) following transforaminal lumbar interbody fusion for lumbar degenerative disc disease, investigating their prevalence, risk factors, and association with clinical outcomes.

SUMMARY OF BACKGROUND DATA

Sclerotic MCs may occur in patients with lumbar degenerative disc disease after lumbar interbody fusion. The incidence and characteristics of postoperative sclerotic MCs, as well as their clinical impact, are unknown.

MATERIALS AND METHODS

The study included 467 patients (510 levels) who underwent single or two-level transforaminal lumbar interbody fusion surgery, divided into a postoperative sclerotic MC group (60 patients, 66 levels) and a non-MC group (407 patients, 444 levels). The time of development and location of postoperative sclerotic MCs, fusion rate, cage subsidence, bilateral process decompression, and cross-link usage were recorded. Preoperative, postoperative, and follow-up visual analogue scale and Oswestry disability index scores were collected. Multivariable logistic regression was used to evaluate factors associated with the development of postoperative sclerotic MCs.

RESULTS

The prevalence of postoperative sclerotic MCs was 12.8%. The postoperative sclerotic MC group had a higher body mass index (BMI). The postoperative sclerotic MC group demonstrated a fusion rate of 47%, significantly lower than that of the non-MC group (71%) at six months post-operation. At final follow-up, the fusion rate in the postoperative sclerotic MC group was 62%, significantly lower than that of the non-MC group (86%). Postoperative visual analogue scale and Oswestry disability index scores were significantly higher in the group with postoperative sclerotic MCs. BMI and osteoporosis were significantly associated with the development of postoperative sclerotic MCs.

CONCLUSION

Postoperative sclerotic MCs generally appear within the first year after surgery, with a prevalence of 12.8%. The presence of postoperative sclerotic MCs can adversely impact postoperative outcomes. To prevent postoperative sclerotic MCs, the authors postulate extending the immobilization period with external bracing and improving the management of BMI and osteoporosis in the perioperative time window.

Modic Changes Increase the Cage Subsidence Rate in Spinal Interbody Fusion Surgery: A Systematic Review and Network Meta-Analysis

OBJECTIVE

To compare the effect of different Modic changes (MC) grades on the cage subsidence rate after spinal interbody fusion surgery.

METHODS

We comprehensively searched the PubMed, Embase, and Web of Science databases from inception to August 13, 2023, for relevant randomized controlled trials and prospective and retrospective cohort studies. Review Manager 5.3 and STATA13.0 were used to conduct this meta-analysis. The subsidence rate was assessed using relative risk and 95% confidence intervals.

RESULTS

Six studies with a total of 716 segments were allocated to four groups according to the type of MC. The subsidence rate in the non-Modic changes (NMC) was significantly lower than that in the MC. The subsidence rate in the NMC was significantly lower than that in the MC in the subgroup of cages with extra instrumentation. No significant difference was identified between the 2 groups in the oblique lumbar interbody fusion subgroup. The subsidence rate in the NMC was significantly lower than that in the MC in the transforaminal lumbar interbody fusion subgroup. The subsidence rate in the NMC was significantly lower than that in the MC1 and MC2. We found no significant difference between NMC and MC3, MC1 and MC2, MC1 and MC3, or MC2 and MC3.

CONCLUSIONS

MC may be associated with a higher cage subsidence rate. With the increase in MC grades, the incidence of subsidence decreased gradually, but it was always higher than that in the NMC. Oblique lumbar interbody fusion may be a better choice for the treatment of lumbar degenerative disease with MC.