Postoperative Modic Changes: What do We Know?

Abstract

Modic changes (MC), initially classified by Modic in 1988, consist of three types: MC1 (hyperintense on T2 weighted imaging T2WI), MC2 (hyperintense on T1 weighted imaging T1WI), and MC3 (hypointense on both T1WI and T2WI). These types are believed to represent different stages of the same disease, potentially resulting from persistent inflammation, altered healing, chronic inflammation, high bone turnover, and fibrosis. In the postoperative setting, Modic changes can be influenced by different types of spinal surgeries such as lumbar spine fusion, lumbar disc surgery, cervical disc surgery, and scoliosis surgery. The impact of these surgical procedures on Modic changes varies depending on the specific technique employed. Following lumbar disc surgery, the natural progression of Modic changes can be affected. It has been observed that certain surgical approaches, such as limited discectomy, may slow down the process of Modic changes. On the other hand, lumbar spine fusion, particularly posterior lumbar interbody fusion (PLIF), does not appear to prevent the development of Modic changes. In the case of cervical disc surgery, the extent of disc resection and the surgical approach employed can have implications for Modic changes. Limited surgical techniques and approaches, which involve less extensive disc resection, have shown better outcomes in terms of Modic changes compared to broader disc resection procedures. The surgical correction of scoliosis aims to restore spinal alignment and balance by fusing the vertebrae together. This fusion process can lead to changes in the adjacent vertebral segments, including the development of Modic changes. The altered biomechanics and stress patterns resulting from spinal fusion may contribute to the occurrence or progression of Modic changes in the postoperative period. Overall, the impact of different spinal surgeries on Modic changes is complex and can vary depending on the specific procedure performed. Further research is needed to better understand the relationship between these surgical interventions and the development or progression of Modic changes in the postoperative period.