The extent of intervertebral disc removal is associated with the occurrence of Modic change after percutaneous endoscopic transforaminal discectomy

Objective Conducted a retrospective study investigating the incidence of postoperative Modic change (PMC) following percutaneous endoscopic transforaminal discectomy (PETD), particularly focus on variables reflecting the degree of intervertebral disc removal to determine whether the extent of disc resection serves as an independent predictor. Methods 167 patients with lumbar disc herniation who underwent PETD were divided into two groups according to the presence (PMC group) or absence (NPMC group) of Modic changes within one year postoperative follow-up. Preoperative demographic characteristics and perioperative imaging parameters were recorded and compared between the two groups. Further multivariate logistic regression analyses were performed for identifying confounding and independent influencing factors. Finally, receiver operating characteristic (ROC) curve analysis was employed to identify the optimal cutoff value of disc removal for the prediction of PMC. Results 52 cases (31.1%) developed PMC. At six months postoperatively, the visual analogue scale (VAS) of the PMC group was significantly higher than that of the control group (p < 0.05). Logistic regression analysis showed that reduced preoperative intervertebral disc height (p = 0.003), large anterior-posterior diameter of the removed intervertebral disc (p = 0.018), and the intervertebral disc removed crossing the midline during surgery (p < 0.001),and the higher Pfirrmann grade (p < 0.001) were independent risk factors for the occurrence of PMC. Conclusion Our study identified an independent association between the extent of intervertebral disc resection during PETD and the incidence of PMC. A prospective study is warranted to investigate the effect of sufficient decompression without aggressive disc resection on postoperative Modic changes.