Disc inflammation and Modic changes show an interaction effect on recovery after surgery for lumbar disc herniation

Purpose To study the interaction between Modic changes (MC) and inflammation by macrophages in the disc, in relation to clinical symptoms before and after discectomy for lumbar disc herniation. Methods Disc tissue was embedded in paraffin and stained with haematoxylin and CD68. Subsequently, tissue...

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Bibliographic Details
Published in:European spine journal 2019-11, Vol.28 (11), p.2579-2587
Main Authors: Djuric, Niek, Yang, Xiaoyu, Ostelo, Raymond W. J. G., van Duinen, Sjoerd G., Lycklama à Nijeholt, Geert J., van der Kallen, Bas F. W., Peul, Wilco C., Vleggeert-Lankamp, Carmen L. A.
Format: Article
Language:English
Subjects:
Adult
Disability Evaluation
Diskectomy
Female
Follow-Up Studies
Humans
Inflammation
Inflammation - diagnostic imaging
Intervertebral Disc - metabolism
Intervertebral Disc Displacement - surgery
Intervertebral discs
Lumbar Vertebrae - diagnostic imaging
Lumbar Vertebrae - surgery
Macrophages
Macrophages - metabolism
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Neurosurgery
Original Article
Pain
Paraffin
Patients
Retrospective Studies
Surgery
Surgical Orthopedics
Visual Analog Scale
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Summary:Purpose To study the interaction between Modic changes (MC) and inflammation by macrophages in the disc, in relation to clinical symptoms before and after discectomy for lumbar disc herniation. Methods Disc tissue was embedded in paraffin and stained with haematoxylin and CD68. Subsequently, tissue samples were categorized for degree of inflammation. Type of MC was scored on MRI at baseline. Roland Disability Questionnaire (RDQ) score and visual analogue scale for back pain and leg pain separately were considered at baseline and 1-year follow-up post-surgery. Main and interaction effects of MC and inflammation were tested against clinical outcome questionnaires. In addition, this analysis was repeated in bulging and extruded discs separately. Results Disc material and MRI’s of 119 patients were retrieved and analysed. Forty-eight patients demonstrated mild inflammation, 45 showed moderate inflammation, and 26 showed considerable inflammation. In total, 49 out of 119 patients demonstrated MC. Grade of disc inflammation did not associate with the presence of MC. At baseline, no main or interaction effects of MC and inflammation were found on the clinical scores. However, during follow-up after discectomy, significant interaction effects were found for RDQ score: Only in patients with MC at baseline, patients remained significantly more disabled (3.2 points p  = 0.006) if they showed considerable disc inflammation compared to patients with mild inflammation. The additional analysis showed similar results in extruded discs, but no significant effects in bulging discs. Conclusions An interaction effect of MC and disc inflammation by macrophages is present. Only in patients with MC, those with considerable inflammation recover less satisfactory during follow-up after surgery. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-019-06108-9