The course of Modic vertebral body changes after posterolateral lumbar fusion on fused and adjacent levels: A systematic review of the literature |
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| Affiliation: | 1. Post-graduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil;2. Division of Emergency – Armed Forces Hospital, Brasília, Brazil;3. Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil;4. Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil;1. Laboratories Department, Children Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt;2. Parasitology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt;3. Clinical Biochemistry Department, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia;4. Biochemistry Department, National Research Centre, Cairo, Egypt;5. Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt;6. Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt;1. Royal Melbourne Hospital, Department of Medicine and Neurology, Melbourne Brain Centre, Melbourne, VIC, Australia;2. Royal Melbourne Hospital, Victorian Infectious Diseases Services, Melbourne, VIC, Australia;3. Western Health, Neurology Department, Melbourne, VIC, Australia;4. Royal Melbourne Hospital, University of Melbourne, Melbourne Brain Centre @ RMH, Department of Nursing, Parkville, VIC, Australia;5. Microbiological Diagnostic Unit Public Health Laboratory (MDU PHL), The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, VIC, Australia;6. James Cook University, College of Medicine and Dentistry, Centre for Biosecurity and Tropical Infectious Diseases, Townsville, QLD, Australia;1. Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan;2. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;3. Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan;4. Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan |
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| Abstract: | According to the original description by Modic et al., the natural course of bone marrow signal abnormalities is an inexorable, progressive one, however recent evidence has demonstrated in healthy individuals and those suffering from lumbar disc herniation that the course of endplate degenerative changes is rather dynamic and sometimes regressive. The evolution of such changes in lumbar fused segments and adjacent levels is largely unknown. The literature relevant to the course of Modic changes on fused and adjacent levels, as well as its clinical correspondence in patients undergoing posterolateral lumbar fusion was collected. Two studies met the criteria. Of 38 patients with Modic type I signals preoperatively, 6 regressed to type 0, 22 progressed to type 2, and 10 remained the same postoperatively. Of 12 patients with Modic type 2 signals preoperatively, 2 regressed to type 0 and 10 remained the same postoperatively. None of the articles described the Modic changes in adjacent levels. Clinical and functional outcomes were significantly improved at follow-up regardless of the endplate signal changes. The best available evidence points out to a reduction in Modic type I frequency on fused segments, either regressive or progressive. There was a predominance of new type II changes in postoperative images, which might represent improvement of instability. This study calls into attention the controversial role of Modic changes as an indicator of clinical significance, since clinical and functional outcomes significantly improved regardless of the endplate signal changes. |
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| Keywords: | Endplate MRI Lumbar fusion Adjacent level Low back pain |
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