Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes.

Peng Cao; Zhe Chen; Yuehuan Zheng; Yuren Wang; Leisheng Jiang; Yaoqi Yang; Chengyu Zhuang; Yu Liang; Tao Zheng; Yaocheng Gong; Xingkai Zhang; Wenjian WU; Shijing Qiu

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Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes.

Author: Peng CAO ¹ ; Zhe CHEN ² ; Yuehuan ZHENG ¹ ; Yuren WANG ³ ; Leisheng JIANG ⁴ ; Yaoqi YANG ¹ ; Chengyu ZHUANG ¹ ; Yu LIANG ¹ ; Tao ZHENG ¹ ; Yaocheng GONG ¹ ; Xingkai ZHANG ¹ ; Wenjian WU ¹ ; Shijing QIU ¹
Author Information

1. Department of Orthopaedics, Ruijin Hospital, School of Medicine, Jiao Tong University and Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopaedics, Shanghai 200025, China.
2. Shanghai Institute of Traumatology and Orthopaedics, Shanghai 200025, China.
3. Department of Orthopaedics, Xinhua Hospital, School of Medicine, Jiao Tong University, Shanghai 200092, China.
4. Department of Orthopaedics, Xinhua Hospital, School of Medicine, Jiao Tong University, Shanghai 200092, China. Email: jiangleisheng@126.com.
Publication Type:Journal Article
MeSH: Adult; Diskectomy; standards; Female; Humans; Intervertebral Disc Displacement; surgery; Low Back Pain; surgery; Lumbar Vertebrae; surgery; Middle Aged; Retrospective Studies; Spinal Fusion; standards
From: Chinese Medical Journal 2014;127(15):2789-2794
CountryChina
Language:English
Abstract:
BACKGROUNDThe purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion (iPLIF) in patients with lumbar disc herniation and Modic endplate changes. Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes (LDH-MC).
METHODSNinety-one patients with single-segment LDH-MC were recruited. All patients experienced low back pain as well as radicular leg pain, and low back pain was more severe than leg pain. Forty-seven patients were treated with discectomy and 44 were treated with iPLIF. The outcomes of both low back pain and radicular leg pain using visual analogue scale (VAS) as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association (JOA) score were assessed before and 18 months after surgery, respectively.
RESULTSBoth low back and leg pain were significantly improved 18 months after simple discectomy and iPLIF. Compared to patients undergoing simple discectomy, low back pain was significantly reduced in patients undergoing iPLIF, but there was no significant difference in leg pain between two groups. Solid fusion was achieved in all patients who underwent iPLIF.
CONCLUSIONSIn patients with LDH-MC, iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy. Simple discectomy can relieve radicular leg pain as efficient as iPLIF. Accordingly, iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.