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      Preoperative Modic changes are related to axial symptoms after anterior cervical discectomy and fusion

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          The objective of this study was to compare the clinical and radiological outcomes between patients with or without axial symptoms (AS) and investigate the risk factors associated with AS by multivariate regression analysis in anterior cervical discectomy and fusion (ACDF).

          Materials and methods

          The records of 117 patients who underwent ACDF were reviewed for clinical and radiological outcomes. These outcomes were evaluated before and after surgery and at the last follow-up. Preoperative Modic changes (MCs) adjacent to the treated disc were identified. Risk factors for AS were detected through logistic regression analysis.


          The patients were divided into two groups: one with AS (AS group, n=35) and the other without (NAS group, n=82). Visual Analog Scale values after the operation ( P=0.013) and at final follow-up ( P<0.001) and preoperative segmental angle ( P=0.031) were significantly different between the two groups. There were no significant differences with respect to other clinical and radiographic outcomes between the two groups ( P>0.05). Logistic regression analysis revealed that preoperative segmental kyphosis (OR =2.912, P=0.035) and MCs (odds ratio =3.268, P=0.015) were the risk factors for the occurrence of AS.


          AS do not correlate with recovery of neural function in patients treated by ACDF. In addition, preoperative segmental kyphosis and MCs at the fusion segment were found to affect the incidence of AS after ACDF.

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          Most cited references 30

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          The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion.

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            Imaging of degenerative disk disease.

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              Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators.

              Herniated intervertebral disc tissue has been shown to produce a number of proinflammatory mediators and cytokines, but there have been no similar studies using discs from patients with discogenic low back pain. We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E2 (PGE2) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay. There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively). The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                26 October 2018
                : 11
                : 2617-2623
                [1 ]Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, People’s Republic of China, xueyuanzyy@ 123456163.com
                [2 ]Department of Orthopedics Surgery, Tianjin Hospital, Hexi District, Tianjin 300211, People’s Republic of China
                Author notes
                Correspondence: Yuan Xue, Department of Orthopedics Surgery, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, People’s Republic of China, Tel +86 22 6081 4688, Fax +86 22 2721 9052, Email xueyuanzyy@ 123456163.com
                © 2018 Zhou et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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