Feasibility of Percutaneous Lumbar Discectomy Combined with Percutaneous Cementoplasty for Symptomatic Lumbar Disc Herniation with Modic Type I Endplate Changes

Background: Treatment of symptomatic lumbar disc herniation with Modic type I endplate changes is complex and challenging, requiring systemic and local therapies which include conservative therapy, epidural infiltrations, percutaneous therapeutic techniques, and surgical options. The clinical management of symptomatic lumbar disc herniation involving Modic type I endplate changes is uniquely challenging because it requires alleviating pain caused by both the herniated disc and the endplate osteochondritis. Through different approaches, percutaneous lumbar discectomy (PLD) and percutaneous cementoplasty (PCP) have been introduced into clinical practice as alternatives to traditional surgical and radiotherapy treatments of symptomatic lumbar disc herniation and other spine diseases. Objective: To evaluate the feasibility of PLD and PCP for symptomatic lumbar disc herniation with Modic type I endplate changes. Study Design: PLD and PCP in 7 patients with symptomatic lumbar disc herniation with Modic type I endplate changes and its clinical effects were retrospectively evaluated. Setting: This study was conducted by an interventional therapy group at a medical center in a major Chinese city. Methods: Seven consecutive patients (2 men, 5 women; median age, 74.14 ± 5.34 years; age range, 68 – 82 years) who underwent percutaneous lumbar discectomy and cementoplasty for the treatment of symptomatic lumbar disc herniation with Modic type I changes between May 2013 and August 2015 were retrospectively analyzed. The MacNab Criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain were assessed before and one week, 6 months, and one year after the procedure. Furthermore, the procedure duration, hospital stay length, and complications were assessed. Results: The VAS of the back and leg decreased from 6.14 ± 0.69 (range, 5 – 7) and 7.29 ± 0.76 (range, 6 – 8) preoperatively to 2.29 ± 1.38 (range, 1 – 5) and 2.71 ± 0.60 (range, 1 – 6) one week, 1.86 ± 0.69 (range, 1 – 3) and 2.00 ± 0.58 (range, 1 – 3) 6 months, and 1.71 ± 0.76 (range, 1 – 3) and 1.85 ± 0.69 (range, 1 – 3) one year postoperatively. The ODI dropped from 76.86 ± 7.45 (range, 70 – 82) preoperatively to 26.29 ± 19.47 (range, 16 – 70) one week, 19.14 ± 2.79 (range, 16 – 24) 6 months, and 18.57 ± 2.99 (range, 16 – 24) one year postoperatively. The mean procedure duration was 55.71 ± 6.07 minutes (range, 50 – 65 minutes). The average length of hospital stay was 7.57 ± 1.27 days (range, 6 – 10 days). No obvious complications were noted. Limitations: This was a retrospective study with a relatively small sample size. Conclusion: PLD plus PCP is a feasible technique for symptomatic lumbar disc herniation with Modic type I endplate changes. Key words: Percutaneous lumbar discectomy, percutaneous cementoplasty, lumbar disc herniation, endplate osteochondritis, Modic type I, feasibility, visual analog scale, Oswestry disability index