The influence of endplate (Modic) changes on clinical outcomes in lumbar spinal stenosis surgery: a Swiss prospective mu
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ORIGINAL ARTICLE
The influence of endplate (Modic) changes on clinical outcomes in lumbar spinal stenosis surgery: a Swiss prospective multicenter cohort study Nils H. Ulrich1,5 · Jakob M. Burgstaller1 · Isaac Gravestock1 · Sebastian Winklhofer2 · François Porchet3 · Giuseppe Pichierri1 · Maria M. Wertli1,4 · Johann Steurer1 · Mazda Farshad5 on behalf of the LSOS Study Group Received: 23 October 2019 / Revised: 26 January 2020 / Accepted: 3 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To investigate if the presence or absence of preoperative endplate Modic changes (MC) is predictive for clinical outcomes in degenerative lumbar spinal stenosis (DLSS) patients undergoing decompression-alone or decompression with instrumented fusion surgery. Methods Two hundred five patients were included and categorized into four groups; 102 patients into the decompressionalone group with MCs, 41 patients into the fusion group with MCs, 46 patients into the decompression-alone group without MCs, and 16 patients into the fusion group without MCs. Clinical outcome was quantified with changes in spinal stenosis measure (SSM) symptoms, SSM function, NRS pain, and EQ-5D-3L sum score over time (measured at baseline, 12-, 24-, and 36-month follow-up) and minimal clinically important difference (MCID) in SSM symptoms, SSM function, and NRS pain from baseline to 36-month follow-up. To investigate if possible effects of MCs had been modified or hidden by confounding variables, we used the group LASSO method to search for good prognostic models. Results There were no obvious differences in any of the clinical outcome measures between groups at baseline. At 12 months, most patients have improved in all outcomes and maintained improved conditions over time (no significant group differences). Between 70 and 90 percent of the patients maintained a clinically important improvement up to 36 months. Conclusions Endplate MCs have no significant influence on clinical outcome parameters in patients with lumbar spinal stenosis compared to patients without MCs, independent of the chosen surgical strategy. All patients benefitted from surgical therapy up to 36-month follow-up. Graphic abstract These slides can be retrieved under Electronic Supplementary Material. Fig. 1: Study Flow
Fig. 2: Boxplots of outcomes and over time
Take Home Messages
Key points
1. Endplate MCs have no significant influence on clinical outcome parameters in patients with lumbar spinal stenosis compared to patients without MCs, independent of the chosen surgical strategy.
1. To investigate if presence or absence of preoperative endplate Modic changes (MC) are predictive for clinical outcomes in degenerative lumbar spinal stenosis (DLSS) patients undergoing decompression alone or decompression with instrumented fusion surgery.
2. All patients manifestly benefitted from surgical therapy up to 36month follow-up.
2. Between 70 and 90 percent of the patients maintained a clinically important improvement up to 36 months. 3. Results o
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