placebo-controlled trial of oral vitamin d and alendronate efficacy for pain and modic changes in lumbar fusion surgery

Background and aim: modic changes are alterations in the spine endplates and subchondral bone shock absorption, seen by magnetic resonance imaging (mri). no studies have investigated the effect of vitamin d and alendronate as oral drugs on reducing and modifying modic changes after degenerative spine fusion surgery. this study aimed to evaluate the efficacy of oral vitamin d and alendronate administration in patients with low back pain, and modic changes undergoing lumbar fusion surgery.methods and materials/patients: a total of 81 middle age women with a normal range of serum vitamin d were enrolled in three groups who underwent lumbar fusion surgery according to neurosurgical criteria. group 1 (n=27) received additional oral alendronate, group 2 (n=27) received oral vitamin d for six months postoperatively, and group 3 (n=27) received no drug (except simple analgesics and antibiotics). the patients were followed up with a visual analog scale (vas) and oswestry disability index (odi). mri was done before and six months after surgery.results: there was no significant difference between the three groups in vas and odi scores (p=0.416, p=0.601, respectively), but the mean vas and odi in all three groups decreased over six months, which was statistically significant (p<0.001). modic changes in all three groups changed significantly over 6 months (p<0.01). in the vitamin d and alendronate groups, modic type 3 increased significantly, but modic type 2 and modic type 1 decreased significantly in the vitamin d and no medication groups, respectively.conclusion: oral vitamin d administration has a desirable effect not only on clinical outcomes after lumbar spinal fusion surgery because of degenerative surgery but also on vertebral endplate modic changes compared to oral bisphosphonate.