• Ichiro Okano, Conor Jones, Colleen Rentenberger, Oliver C Sax, Stephan N Salzmann, Marie-Jacqueline Reisener, Jennifer Shue, John A Carrino, Andrew A Sama, Frank P Cammisa, Federico P Girardi, and Alexander P Hughes.
• Spine Care Institute, Hospital for Special Surgery, New York, NY.
• Spine. 2020 Dec 1; 45 (23): E1580-E1587.

Study DesignRetrospective case series.ObjectiveThe aim of this study was to investigate the association of Modic type endplate changes with the risk of severe subsidence after standalone lateral lumbar interbody fusion (SA-LLIF).Summary Of Background DataIt has been reported that certain endplate radiolographic features are associated with higher regional bone mineral density (BMD) in the adjacent vertebrae in the lumbar spine. It remains unclear whether these changes have protective effects against osteoporotic complications such as cage subsidence after lumbar surgery.MethodsWe reviewed patients undergoing SA-LLIF from 2007 to 2016 with a follow-up >6 months. Cage subsidence was assessed utilizing the grading system by Marchi et al. As potential contributing factors for cage subsidence, we measured the endplate volumetric BMD (EP-vBMD) and the standard trabecular volumetric BMD measurement in the vertebral body. Modic changes (MC) on magnetic resonance imaging were measured as a qualitative factor for endplate condition. Univariate analysis and multivariate logistic regression analyses with a generalized mixed model were conducted.ResultsTwo hundred six levels in 97 patients were included in the final analysis. Mean age (± SD) was 66.7 ± 10.7. Sisty-sdpercent of the patients were female. Severe subsidence was observed in 66 levels (32.0%). After adjusting for age, bone morphogenetic protein (BMP) use, and number of levels fused, the presence of MC type 2 was significantly associated with lower risk of severe subsidence (OR = 0.28 [0.09-0.88], P = 0.029). Whereas, EP-vBMD did not demonstrate a statistical significance (p = 0.600).ConclusionThe presence of a Modic type 2 change was significantly associated with lower odds of severe subsidence after SA-LLIF. Nonetheless, this significant association was independent from regional EP-vBMD values. This finding suggests that microstructural and/or material property changes associated with Modic type 2 changes might have a protective effect in this patient population.Level Of Evidence4.

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