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 decompression-alone 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.

中文翻译：

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终板（Modic）变化对腰椎管狭窄手术的临床结局的影响：一项瑞士前瞻性多中心队列研究。

摘要

目的

调查是否存在术前终板的Modic改变（MC）是否可预测行单纯减压或采用器械融合手术减压的退行性腰椎管狭窄（DLSS）患者的临床结局。

方法

纳入255例患者，分为四组。合并有MC的单纯减压组102例，合并MC的融合组41例，无MC的单纯减压组46例，无MC的融合组16例。通过随时间变化的椎管狭窄测量（SSM）症状，SSM功能，NRS疼痛和EQ-5D-3L总评分来量化临床结局（在基线，12个月，24个月和36个月随访时测量）从基线到36个月的随访期间，SSM症状，SSM功能和NRS疼痛的临床意义最小差异（MCID）最小。为了研究MC的可能影响是否已通过混淆变量来修改或隐藏，我们使用组LASSO方法搜索良好的预后模型。

结果

基线时各组之间的任何临床结局指标均无明显差异。在12个月时，大多数患者的所有结局均得到改善，并且随着时间的推移保持了改善的状态（无显着组别差异）。70％至90％的患者在长达36个月的时间内保持了重要的临床改善。

结论

与无MC的患者相比，终板MC对腰椎管狭窄症患者的临床结局参数没有显着影响，而与所选择的手术策略无关。所有患者在长达36个月的随访中均从手术治疗中受益。

图形摘要

这些幻灯片可以在电子补充材料下找到。