Success of lumbar microdiscectomy in patients with modic changes and low-back pain: a prospective pilot study
Prospective case controlled. To determine the outcome after microdiscectomy in patients with disc herniation, concordant sciatica, and low-back pain with Modic I and II degenerative changes compared with similar patients without Modic changes. The decision to perform a microdiscectomy versus a fusio...
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Veröffentlicht in: | Journal of spinal disorders & techniques 2008-04, Vol.21 (2), p.139-144 |
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creator | Chin, Kingsley R Tomlinson, Daniel T Auerbach, Joshua D Shatsky, Joshua B Deirmengian, Carl A |
description | Prospective case controlled.
To determine the outcome after microdiscectomy in patients with disc herniation, concordant sciatica, and low-back pain with Modic I and II degenerative changes compared with similar patients without Modic changes.
The decision to perform a microdiscectomy versus a fusion or total disc replacement in a patient with a disc herniation and sciatica may be confounded by the presence of low-back pain, degenerative disc disease, and marrow and endplate (Modic) changes.
Thirty consecutive patients underwent a microdiscectomy by a single surgeon. Group 1 consisted of 15 patients, 6 men and 9 women, with a mean age of 36.7 years (range, 21 to 48 y), with Modic I and II changes. Group 2 contained 15 patients, 9 men and 6 women, with a mean age of 34.1 years (range, 20 to 68 y), without Modic changes. The average duration of low-back pain before surgery was 25.6 months (range 4 to 120 mo) in group 1 and 17.5 months (range 5 to 120 mo) in group 2. The visual analog scale (VAS) was used to grade low-back pain and the Oswestry score was used to grade overall disability.
There was no significant difference in preoperative sciatica, low-back pain, VAS or Oswestry scores for group 1 versus group 2 patients. Postoperatively, all patents had improved sciatica and resolution of any nerve tension sign. Eighty-six percent of patients in group 1 versus 93% of patients in group 2 had improvements in postoperative VAS score for low-back pain at 6 months. Average improvement within each group was 67% and 75%, respectively. VAS scores for low-back pain at 6 months improved from 6.9 to 2.3 (P=0.0005) in group 1 and 6.3 to 1.6 (P=0.0002) in group 2. Group 1 and 2 had 89% and 100% of patients show improvement in postoperative Oswestry score at 6 months with an average improvement of 58% and 84%, respectively. Oswestry scores at 6 months improved from 68.7% to 28.8% (P=0.0007) in group 1 and 61.2% to 9.9% (P=0.00003) in group 2.
There was a trend toward greater improvement in Oswestry scores in patients without Modic changes (P=0.09). Both groups reported statistically significant improvement in sciatica, low-back pain, and disability after microdiscectomy. Microdiscectomy was therefore an effective treatment for disc herniation and concordant sciatica despite low-back pain and Modic I and II degenerative changes.
Therapeutic II. |
doi_str_mv | 10.1097/BSD.0b013e318093e5dc |
format | Article |
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To determine the outcome after microdiscectomy in patients with disc herniation, concordant sciatica, and low-back pain with Modic I and II degenerative changes compared with similar patients without Modic changes.
The decision to perform a microdiscectomy versus a fusion or total disc replacement in a patient with a disc herniation and sciatica may be confounded by the presence of low-back pain, degenerative disc disease, and marrow and endplate (Modic) changes.
Thirty consecutive patients underwent a microdiscectomy by a single surgeon. Group 1 consisted of 15 patients, 6 men and 9 women, with a mean age of 36.7 years (range, 21 to 48 y), with Modic I and II changes. Group 2 contained 15 patients, 9 men and 6 women, with a mean age of 34.1 years (range, 20 to 68 y), without Modic changes. The average duration of low-back pain before surgery was 25.6 months (range 4 to 120 mo) in group 1 and 17.5 months (range 5 to 120 mo) in group 2. The visual analog scale (VAS) was used to grade low-back pain and the Oswestry score was used to grade overall disability.
There was no significant difference in preoperative sciatica, low-back pain, VAS or Oswestry scores for group 1 versus group 2 patients. Postoperatively, all patents had improved sciatica and resolution of any nerve tension sign. Eighty-six percent of patients in group 1 versus 93% of patients in group 2 had improvements in postoperative VAS score for low-back pain at 6 months. Average improvement within each group was 67% and 75%, respectively. VAS scores for low-back pain at 6 months improved from 6.9 to 2.3 (P=0.0005) in group 1 and 6.3 to 1.6 (P=0.0002) in group 2. Group 1 and 2 had 89% and 100% of patients show improvement in postoperative Oswestry score at 6 months with an average improvement of 58% and 84%, respectively. Oswestry scores at 6 months improved from 68.7% to 28.8% (P=0.0007) in group 1 and 61.2% to 9.9% (P=0.00003) in group 2.
There was a trend toward greater improvement in Oswestry scores in patients without Modic changes (P=0.09). Both groups reported statistically significant improvement in sciatica, low-back pain, and disability after microdiscectomy. Microdiscectomy was therefore an effective treatment for disc herniation and concordant sciatica despite low-back pain and Modic I and II degenerative changes.
Therapeutic II.</description><identifier>ISSN: 1536-0652</identifier><identifier>DOI: 10.1097/BSD.0b013e318093e5dc</identifier><identifier>PMID: 18391720</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Disability Evaluation ; Diskectomy - methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement - pathology ; Intervertebral Disc Displacement - surgery ; Low Back Pain - surgery ; Lumbar Vertebrae - pathology ; Lumbar Vertebrae - surgery ; Magnetic Resonance Imaging ; Male ; Microsurgery - methods ; Middle Aged ; Pilot Projects ; Prospective Studies ; Sciatica - pathology ; Sciatica - surgery ; Spinal Fusion - methods ; Treatment Outcome</subject><ispartof>Journal of spinal disorders & techniques, 2008-04, Vol.21 (2), p.139-144</ispartof><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c254t-a26982325718e3485aa8cf239cd2da4d1d1e5171534fa4ee7c11d961ccad290e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27925,27926</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18391720$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chin, Kingsley R</creatorcontrib><creatorcontrib>Tomlinson, Daniel T</creatorcontrib><creatorcontrib>Auerbach, Joshua D</creatorcontrib><creatorcontrib>Shatsky, Joshua B</creatorcontrib><creatorcontrib>Deirmengian, Carl A</creatorcontrib><title>Success of lumbar microdiscectomy in patients with modic changes and low-back pain: a prospective pilot study</title><title>Journal of spinal disorders & techniques</title><addtitle>J Spinal Disord Tech</addtitle><description>Prospective case controlled.
To determine the outcome after microdiscectomy in patients with disc herniation, concordant sciatica, and low-back pain with Modic I and II degenerative changes compared with similar patients without Modic changes.
The decision to perform a microdiscectomy versus a fusion or total disc replacement in a patient with a disc herniation and sciatica may be confounded by the presence of low-back pain, degenerative disc disease, and marrow and endplate (Modic) changes.
Thirty consecutive patients underwent a microdiscectomy by a single surgeon. Group 1 consisted of 15 patients, 6 men and 9 women, with a mean age of 36.7 years (range, 21 to 48 y), with Modic I and II changes. Group 2 contained 15 patients, 9 men and 6 women, with a mean age of 34.1 years (range, 20 to 68 y), without Modic changes. The average duration of low-back pain before surgery was 25.6 months (range 4 to 120 mo) in group 1 and 17.5 months (range 5 to 120 mo) in group 2. The visual analog scale (VAS) was used to grade low-back pain and the Oswestry score was used to grade overall disability.
There was no significant difference in preoperative sciatica, low-back pain, VAS or Oswestry scores for group 1 versus group 2 patients. Postoperatively, all patents had improved sciatica and resolution of any nerve tension sign. Eighty-six percent of patients in group 1 versus 93% of patients in group 2 had improvements in postoperative VAS score for low-back pain at 6 months. Average improvement within each group was 67% and 75%, respectively. VAS scores for low-back pain at 6 months improved from 6.9 to 2.3 (P=0.0005) in group 1 and 6.3 to 1.6 (P=0.0002) in group 2. Group 1 and 2 had 89% and 100% of patients show improvement in postoperative Oswestry score at 6 months with an average improvement of 58% and 84%, respectively. Oswestry scores at 6 months improved from 68.7% to 28.8% (P=0.0007) in group 1 and 61.2% to 9.9% (P=0.00003) in group 2.
There was a trend toward greater improvement in Oswestry scores in patients without Modic changes (P=0.09). Both groups reported statistically significant improvement in sciatica, low-back pain, and disability after microdiscectomy. Microdiscectomy was therefore an effective treatment for disc herniation and concordant sciatica despite low-back pain and Modic I and II degenerative changes.
Therapeutic II.</description><subject>Adult</subject><subject>Disability Evaluation</subject><subject>Diskectomy - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intervertebral Disc Displacement - pathology</subject><subject>Intervertebral Disc Displacement - surgery</subject><subject>Low Back Pain - surgery</subject><subject>Lumbar Vertebrae - pathology</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>Pilot Projects</subject><subject>Prospective Studies</subject><subject>Sciatica - pathology</subject><subject>Sciatica - surgery</subject><subject>Spinal Fusion - methods</subject><subject>Treatment Outcome</subject><issn>1536-0652</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkLtOwzAUhj2AaCm8AUKe2FJ8y8VsUK5SJYbCHDn2CTXESYgdqr49rloJiekM_0Xn_xC6oGROicyv71b3c1IRyoHTgkgOqdFHaEpTniUkS9kEnXr_SQjNuRAnaEILLmnOyBS51ag1eI-7Gjejq9SAndVDZ6zXoEPntti2uFfBQhs83tiwxi6qGuu1aj_AY9Ua3HSbpFL6Kxpte4MV7ofO9zFvfwD3tukC9mE02zN0XKvGw_nhztD748Pb4jlZvj69LG6XiWapCIlimSwYZ2lOC-CiSJUqdM241IYZJQw1FFKax3miVgIg15QamVGtlWGSAJ-hq31v_ON7BB9Kt9vTNKqFbvRlTkTBpMiiUeyNcbL3A9RlP1inhm1JSblDW0a05X-0MXZ56B8rB-YvdODKfwHF7Xm8</recordid><startdate>200804</startdate><enddate>200804</enddate><creator>Chin, Kingsley R</creator><creator>Tomlinson, Daniel T</creator><creator>Auerbach, Joshua D</creator><creator>Shatsky, Joshua B</creator><creator>Deirmengian, Carl A</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200804</creationdate><title>Success of lumbar microdiscectomy in patients with modic changes and low-back pain: a prospective pilot study</title><author>Chin, Kingsley R ; Tomlinson, Daniel T ; Auerbach, Joshua D ; Shatsky, Joshua B ; Deirmengian, Carl A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c254t-a26982325718e3485aa8cf239cd2da4d1d1e5171534fa4ee7c11d961ccad290e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Disability Evaluation</topic><topic>Diskectomy - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intervertebral Disc Displacement - pathology</topic><topic>Intervertebral Disc Displacement - surgery</topic><topic>Low Back Pain - surgery</topic><topic>Lumbar Vertebrae - pathology</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>Pilot Projects</topic><topic>Prospective Studies</topic><topic>Sciatica - pathology</topic><topic>Sciatica - surgery</topic><topic>Spinal Fusion - methods</topic><topic>Treatment Outcome</topic><toplevel>online_resources</toplevel><creatorcontrib>Chin, Kingsley R</creatorcontrib><creatorcontrib>Tomlinson, Daniel T</creatorcontrib><creatorcontrib>Auerbach, Joshua D</creatorcontrib><creatorcontrib>Shatsky, Joshua B</creatorcontrib><creatorcontrib>Deirmengian, Carl A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of spinal disorders & techniques</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chin, Kingsley R</au><au>Tomlinson, Daniel T</au><au>Auerbach, Joshua D</au><au>Shatsky, Joshua B</au><au>Deirmengian, Carl A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Success of lumbar microdiscectomy in patients with modic changes and low-back pain: a prospective pilot study</atitle><jtitle>Journal of spinal disorders & techniques</jtitle><addtitle>J Spinal Disord Tech</addtitle><date>2008-04</date><risdate>2008</risdate><volume>21</volume><issue>2</issue><spage>139</spage><epage>144</epage><pages>139-144</pages><issn>1536-0652</issn><abstract>Prospective case controlled.
To determine the outcome after microdiscectomy in patients with disc herniation, concordant sciatica, and low-back pain with Modic I and II degenerative changes compared with similar patients without Modic changes.
The decision to perform a microdiscectomy versus a fusion or total disc replacement in a patient with a disc herniation and sciatica may be confounded by the presence of low-back pain, degenerative disc disease, and marrow and endplate (Modic) changes.
Thirty consecutive patients underwent a microdiscectomy by a single surgeon. Group 1 consisted of 15 patients, 6 men and 9 women, with a mean age of 36.7 years (range, 21 to 48 y), with Modic I and II changes. Group 2 contained 15 patients, 9 men and 6 women, with a mean age of 34.1 years (range, 20 to 68 y), without Modic changes. The average duration of low-back pain before surgery was 25.6 months (range 4 to 120 mo) in group 1 and 17.5 months (range 5 to 120 mo) in group 2. The visual analog scale (VAS) was used to grade low-back pain and the Oswestry score was used to grade overall disability.
There was no significant difference in preoperative sciatica, low-back pain, VAS or Oswestry scores for group 1 versus group 2 patients. Postoperatively, all patents had improved sciatica and resolution of any nerve tension sign. Eighty-six percent of patients in group 1 versus 93% of patients in group 2 had improvements in postoperative VAS score for low-back pain at 6 months. Average improvement within each group was 67% and 75%, respectively. VAS scores for low-back pain at 6 months improved from 6.9 to 2.3 (P=0.0005) in group 1 and 6.3 to 1.6 (P=0.0002) in group 2. Group 1 and 2 had 89% and 100% of patients show improvement in postoperative Oswestry score at 6 months with an average improvement of 58% and 84%, respectively. Oswestry scores at 6 months improved from 68.7% to 28.8% (P=0.0007) in group 1 and 61.2% to 9.9% (P=0.00003) in group 2.
There was a trend toward greater improvement in Oswestry scores in patients without Modic changes (P=0.09). Both groups reported statistically significant improvement in sciatica, low-back pain, and disability after microdiscectomy. Microdiscectomy was therefore an effective treatment for disc herniation and concordant sciatica despite low-back pain and Modic I and II degenerative changes.
Therapeutic II.</abstract><cop>United States</cop><pmid>18391720</pmid><doi>10.1097/BSD.0b013e318093e5dc</doi><tpages>6</tpages></addata></record> |
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subjects | Adult Disability Evaluation Diskectomy - methods Female Follow-Up Studies Humans Intervertebral Disc Displacement - pathology Intervertebral Disc Displacement - surgery Low Back Pain - surgery Lumbar Vertebrae - pathology Lumbar Vertebrae - surgery Magnetic Resonance Imaging Male Microsurgery - methods Middle Aged Pilot Projects Prospective Studies Sciatica - pathology Sciatica - surgery Spinal Fusion - methods Treatment Outcome |
title | Success of lumbar microdiscectomy in patients with modic changes and low-back pain: a prospective pilot study |
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