脊柱杂志

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Disc Lesion with Modic Changes

Abstract

Yasuhito Kaneko, Ken Ishii, Masaya Nakamura, Takahiro Koyanagi and Morio Matsumoto

Purpose: This study was conducted to assess short- to mid-range clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for patients with severe low back pain caused by intervertebral disc degeneration showing Modic changes on MRI.

Methods: Thirty-five consecutive patients (mean age: 48.6 years) who underwent single-level MIS-TLIF to treat severe low back pain with Modic changes on MRI were included. Diagnoses were based on temporary pain relief after an intradiscal anesthetic injection, selective nerve blocking, or both. The mean follow-up period was 18 months. Japanese Orthopaedic Association (JOA) scores (29 possible points), JOA-score recovery rates (RR), Visual Analog Pain Scale (VAS) scores for low back pain, and the Oswestry Disability Index (ODI) were evaluated.

Results: The average JOA score improved significantly, from 14.8 ± 3.6 preoperatively to 26.9 ± 1.6 at the final follow-up (P < 0.01). The average JOA-score RR was 84.8 ± 11.7%. Significant improvements were obtained in the average VAS scores for low back pain (preoperative, 7.8 ± 1.9; final follow-up, 1.5 ± 0.7; P < 0.01) and ODI (preoperative, 57.9 ± 16.1; final follow-up, 13.0 ± 8.8; P < 0.01). Modic type 1 changes were observed in 12 patients, and type 2 changes in 23 patients. The JOA-score RR did not differ significantly between patients with Modic type 1 and type 2 (85.7% and 84.1%, respectively).

Conclusions: MIS-TLIF, which is less damaging to the paraspinal muscles than conventional approaches, is a reasonable surgical option for lumbar disc lesion with Modic type 1 and 2 changes.