Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes

Background The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion （iPLIF） in patients with lumbar disc herniation and Modic endplate changes.Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes （LDH-MC）.Methods Ninety-one patients with single-segment LDH-MC were recruited.All patients experienced low back pain as well as radicular leg pain,and low back pain was more severe than leg pain.Forty-seven patients were treated with discectomy and 44 were treated with iPLIE The outcomes of both low back pain and radicular leg pain using visual analogue scale （VAS） as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association （JOA） score were assessed before and 18 months after surgery,respectively.Results Both low back and leg pain were significantly improved 18 months after simple discectomy and iPLIE Compared to patients undergoing simple discectomy,low back pain was significantly reduced in patients undergoing iPLIE but there was no significant difference in leg pain between two groups.Solid fusion was achieved in all patients who underwent iPLIF.Conclusions In patients with LDH-MC,iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy.Simple discectomy can relieve radicular leg pain as efficient as iPLIE Accordingly,iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.

Intraosseous Radiofrequency Ablation of the Basivertebral Nerve in Chronic Low Back Pain: A Meta-Analysis

Purpose: To review the literature on the value of basivertebral nerve abla-tion in the treatment of chronic low back pain. Materials and Method: A systematic review and meta-analysis of the English literature to March 2020 was undertaken. The inclusion criteria were patients with discogenic back pain of more than 3 months duration with modic type 1 or 2 change and suc-cessful disc block or discogram. Primary outcomes were VAS pain, ODI, EQ-5D and SF36 improvement. Secondary outcomes were complications. Results: 6 studies were included, all funded by the same company, but oth-erwise of low bias. All studies showed significant improvement in all scores over the first 3 months with evidence these would be maintained over the longer term. There was one reported compression fracture, but otherwise no significant adverse events. Conclusion: This study supports the conclusion that radiofrequency ablation of the basivertebral nerve is a safe and effective treatment for discogenic chronic low back pain.