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Ten-Year Clinical Outcomes After Decompression Surgery for Lumbar Spinal Stenosis: The Impact of Preoperative Modic Changes
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Ten-Year Clinical Outcomes After Decompression Surgery for Lumbar Spinal Stenosis: The Impact of Preoperative Modic Changes
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Ten-Year Clinical Outcomes After Decompression Surgery for Lumbar Spinal Stenosis: The Impact of Preoperative Modic Changes
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Journal Article
Ten-Year Clinical Outcomes After Decompression Surgery for Lumbar Spinal Stenosis: The Impact of Preoperative Modic Changes
2026
Overview
Study Design
Retrospective Cohort Study.
Objective
Modic changes (MCs) have been associated with low back pain; however, their prognostic value in surgical outcomes—particularly in patients with lumbar spinal stenosis (LSS) treated with decompression alone—remains unclear. Few studies have investigated the progression and long-term clinical impact of MCs. This study aimed to evaluate the 10-year progression of MCs and their association with clinical outcomes following posterior decompression surgery for LSS.
Methods
This study included 62 patients who underwent posterior decompression for LSS and completed a 10-year follow-up with MRI and clinical assessments. MCs and disc degeneration were evaluated using standardized MRI criteria. Japanese Orthopaedic Association (JOA) scores and recovery rates were assessed preoperatively and at follow-up. Outcomes were compared between Modic-negative patients and those with preoperative Modic Type 1 or Type 2 changes. Analysis of covariance adjusted for confounding variables.
Results
The prevalence of MCs increased from 37.1% preoperatively to 74.2% at 10 years. Type 1 changes were dynamic, often progressing to Type 2 or 3. Type 2 changes were more stable and associated with significantly lower postoperative JOA scores and recovery rates compared to Modic-negative or Type 1 patients (P < 0.05), after adjustment for age, sex, sagittal alignment parameters, and disc degeneration. Type 2 MCs were also linked with minimal improvement in back pain.
Conclusion
Modic changes, particularly Type 2, are associated with inferior long-term outcomes. These findings suggest that Modic Type 2 may serve as a prognostic marker of advanced degeneration and may be associated with reduced recovery following decompression surgery.
Publisher
SAGE Publications,Sage Publications Ltd,SAGE Publishing
