Modic change grade has been identified as a clinically significant biomarker.

This study analyzed MCG in patients undergoing lumbar spinal stenosis surgery.

Patients with MCG-B+ exhibited inferior outcomes at two-year follow-up.

Modic type (MC1–3) showed no prognostic value; MCG was predictive.

Surgical planning and prognostication should include MCG in LSS patients.

Registry-based cohort study.

To evaluate the impact of the Modic Change Grade (MCG) on patient-reported outcomes (PROs) in patients undergoing lumbar spinal stenosis (LSS) surgery.

A register-based cohort study was performed. Lumbar MRIs were graded based on the vertical extent of vertebral body MC involvement with MCG-A (<25 %), MCG-B (25–50 %), and MCG-C (>50 %). Patients were divided into two groups: Minor MC (MCG-A) and Major MC (MCG-B+). PROs, including the Visual Analogue Scale for back pain (VAS-BP), leg pain (VAS-LP), and Oswestry Disability Index (ODI), were collected.

Of 208 patients included, there was no significant difference in preoperative PROs. At two-year follow-up, patients with major MC had significantly worse mean VAS-BP (32 vs 44, p = 0.045), VAS-LP (27 vs 45, p = 0.003), and ODI scores (22 vs 30, p = 0.036) compared to patients with minor MC.

This is the first study to evaluate the association between MCG and PROs in patients undergoing LSS surgery. Major MC was associated with significantly worse pain and disability scores at two-year follow-up. Future studies should incorporate the MCG to further investigate the potential impact of MC phenotypes on PROs.

Modic changes

Low back pain

Lumbar stenosis

Spine surgery

Disc degeneration

© 2025 The Authors. Published by Elsevier B.V.