Modic Change after Intradiscal Condoliase Injection Therapy for Lumbar Disc Herniation

Abstract

Introduction: Literature on good short-term results of intradiscal condoliase injection therapy for lumbar disc herniation are found. However, few reports have focused on its side effects. In this study, we examined the transition of Modic changes after intravertebral disc injection therapy with condoliase.

Methods: In total, 74 patients (48 males and 26 females), who were treated with condoliase injections and followed-up for >6 months, were enrolled in this prospective study. Their mean age was 46.8 years (range: 17-80 years). We investigated Visual Analog Scale (VAS) scores for low back pain and Oswestry disability index (ODI) as clinical assessments at preinjection, and 1, 3, and 6 months postinjection. Imaging evaluation was performed using MRI to examine disc height, Modic changes, and the progression of disc degeneration using Pfirrmann classification.

Results: The mean VAS score for low back pain notably improved from 5.2 preinjection to 2.2 postinjection, and ODI also improved from 39.0 to 14.5. The disc height decreased from 9.5 mm preinjection to 8.5 mm postinjection. Alteration of Modic changes was finally seen in seven cases, where newly type 1 appeared, and in five cases, where type 2 was changed to type 1. Progressive disc degeneration was observed in 41 cases. No significant difference was observed in the VAS for low back pain at either period despite the alteration of Modic changes, and a decrease in disc height or progression of disc degeneration at 6 months after injection were not significant factors of the alteration of Modic changes.

Conclusions: The alteration of Modic changes was observed in 12 patients (16%) at 6 months postinjection and did not correlate with a decrease in disc height or progression of disc degeneration. Although the lower back pain did not worsen despite the alteration of Modic changes, long-term follow-up will be necessary in the future.