J Minim Invasive Spine Surg Tech.  2025 Apr;10(1):162-169. 10.21182/jmisst.2024.01879.

Clinical Outcomes of Full-Endoscopic Disc Cleaning Surgery for Chronic Low Back Pain Associated with Modic Changes: A Case Series

• Sugiura K
• Soeda S
• Morimoto M
• Manabe H
• Tezuka F
• Yamashita K
• Sairyo K

• KMID: 2567510
• DOI: http://doi.org/10.21182/jmisst.2024.01879

Abstract

This article reports a case series evaluating the short-term clinical outcomes of full-endoscopic disc cleaning (FEDC), which is one of the most minimally invasive surgical procedures for treating chronic low back pain (CLBP) due to Modic changes (MCs). Seven patients who underwent FEDC at Tokushima University Hospital between 2019 and 2021, with postoperative clinical outcomes available over a follow-up period of more than 12 months, were included in the study. Six men and one woman underwent FEDC. The average age of the patients was 48.7 years with an average CLBP duration of 9.4 years. Five of these patients showed favorable outcomes, with reductions in LBP. The other 2 required revision surgery at the 12-month follow-up due to recurrent symptoms. One of the patients who required revision surgery was the oldest in this series, a 73-year-old woman with mixed signal changes including Modic type 3 at the anterior corner at L2–3 to L4–5 levels with spinal malalignment. Although disc block was immediately effective, pain reproduction on discography yielded unclear results. The clinical outcomes of this series suggest that FEDC may be particularly effective for patients with inflammatory type 1 and type 2 changes and less advanced degenerative changes. However, in cases involving more complex degeneration, such as type 3 changes or notable spinal deformities, CLBP may arise from multiple contributing factors beyond MCs alone, underscoring the importance of a thorough evaluation when determining surgical indications for FEDC.

Keyword

Low back pain; Modic changes; Disc cleaning; Local anesthesia