Type 2 sclerotic Modic change affect fusion result in patients undergoing PLIF with pedicle screw instrumentation: a retrospective study

• Main Authors: Hao Li, Shou Chen, He-Yu Wei, Chuang-Ye Han, Fan-Yue Zeng, Shuang-Shuang Yuan, Hong-Yu Qin, Jin-Song Yang
• Format: Article
• Language: English
• Published: BMC 2021-06-01
• Series: BMC Musculoskeletal Disorders
• Subjects: Modic changes; Endplate sclerosis; Posterior lumbar interbody fusion; Pedicle screw instrumentation; Bony fusion
• Online Access: https://doi.org/10.1186/s12891-021-04461-9

Abstract Background Bony fusion rate was significantly lower in patients with type 3 Modic change than patients with normal endplates. It is not known whether there are relevant differences in fusion efficiency among patients with type 2 sclerotic Modic change or non-sclerotic Modic change, or no Modic change. Methods A retrospective study contained 196 lumbar segments in 123 subjects undergoing posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation (PSI) to assess the effect of type 2 sclerotic Modic change on fusion efficiency. These endplates were allocated into groups A, B, and C, according to their Modic changes. Group A had endplates with type 2 Modic change and endplate sclerosis. Group B had type 2 Modic change without endplate sclerosis. Group C had neither Modic change nor endplate sclerosis. The presence of Modic change was determined by magnetic resonance imaging (MRI). Endplate sclerosis in type 2 Modic change was detected by computed tomography (CT) before the operation. We collected CT data 3 months to more than 24 months after operation in patients to assess bony fusion. Results Incidences of bony fusion were 58.8% in group A, 95.0% in group B, 94.3% in group C. The bony fusion rate was significantly lower in group A than in either group B or C. There was no significant difference between groups B and C. Thus, endplates with type 2 sclerotic Modic change had a lower fusion rate in patients undergoing PLIF with PSI. Conclusion Type 2 sclerotic Modic change could be an important factor that affects solid bony fusion in patients undergoing PLIF with PSI. CT may help diagnose endplate sclerosis in patients with type 2 change and inform the choice of the best site for spinal fusion.