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01-09-2020 | Spinal Stenosis | Original Article

The influence of endplate (Modic) changes on clinical outcomes in lumbar spinal stenosis surgery: a Swiss prospective multicenter cohort study

Authors: Nils H. Ulrich, Jakob M. Burgstaller, Isaac Gravestock, Sebastian Winklhofer, François Porchet, Giuseppe Pichierri, Maria M. Wertli, Johann Steurer, Mazda Farshad, the LSOS Study Group

Published in: European Spine Journal | Issue 9/2020

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 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.

Available only for authorised users

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Title: The influence of endplate (Modic) changes on clinical outcomes in lumbar spinal stenosis surgery: a Swiss prospective multicenter cohort study
Authors: Nils H. Ulrich
Jakob M. Burgstaller
Isaac Gravestock
Sebastian Winklhofer
François Porchet
Giuseppe Pichierri
Maria M. Wertli
Johann Steurer
Mazda Farshad
the LSOS Study Group
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Keyword: Spinal Stenosis
Published in: European Spine Journal / Issue 9/2020
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-020-06364-0

At a glance: The STEP trials

Springer Medicine

The influence of endplate (Modic) changes on clinical outcomes in lumbar spinal stenosis surgery: a Swiss prospective multicenter cohort study

Abstract

Purpose

Methods

Results

Conclusions

Graphic abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Graphic abstract

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