Abstract
PURPOSE: This study aims to identify the association between preoperative Modic changes and the recurrence of lumbar disc herniation (LDH) in patients who have undergone percutaneous endoscopic lumbar discectomy (PELD). METHODS: The PubMed, Web of Science, EMBASE, and CNKI databases were searched from their inception until 19 March 2025. Early recurrence was defined as herniation occurring within 6 months postoperatively, whereas late recurrence referred to herniation occurring after 12 months. Odds ratios (ORs) with 95% confidence intervals (CIs) were combined, and subgroup analyses were conducted according to the recurrence type. RESULTS: Twenty-seven studies involving 10,116 patients were included, with the majority of studies originating from China (25/27). The recurrence rates for patients without and with Modic changes were 7.44% and 16.41%, respectively (type I: 15.01%; type II/III: 18.14%; P < 0.001). The presence of Modic changes was associated with a significantly increased risk of recurrence (OR = 2.96, 95% CI: 2.29-3.82, P < 0.001), and subgroup analyses by the recurrence period (early or late) showed consistent findings. However, patients with Modic type II/III changes did not have a higher risk of recurrence than those with Modic type I changes (OR = 1.13, P = 0.217). CONCLUSION: Preoperative Modic changes are associated with postoperative recurrence among LDH patients undergoing PELD, and the presence of Modic changes is related to a significantly higher risk of early and late recurrence.