Abstract
To the Editor,
We commend Watanabe et al for their insightful study, “Ten-Year Clinical Outcomes After Decompression Surgery for Lumbar Spinal Stenosis: The Impact of Preoperative Modic Changes” (Global Spine Journal, 2025; DOI: 10.1177/21925682251361034), which provides valuable long-term data on Modic changes (MCs) and their influence on surgical outcomes. The detailed longitudinal analysis of MC progression significantly contributes to our understanding of postoperative recovery in lumbar spinal stenosis. Upon review, we noted a potential discrepancy regarding participant age. While the inclusion criteria specified patients aged 50-75 years, the reported age range of the final cohort was 41-82 years. This inconsistency may influence cohort homogeneity and the interpretation of results.
Age is a well-established determinant of both surgical outcomes and the prevalence of MCs. Jensen et al reported that vertebral endplate signal changes, commonly referred to as Modic changes, increase with age, with an estimated rise of 11% per decade at the individual level and 6% per decade at the lumbar level (P < 0.05). 1 Similarly, Wang et al demonstrated that advancing age is associated with a higher likelihood of multiple MCs in the lumbar spine. 2 These findings underscore the importance of clearly defining age in studies evaluating MCs and their impact on surgical outcomes.
We respectfully suggest that the authors clarify the age range of their study population and discuss the potential implications of including participants outside the predefined criteria. Such clarification would enhance the transparency and interpretability of this important long-term investigation, consistent with the STROBE guidelines for observational studies. 3
We sincerely appreciate the authors’ contribution to this field and the journal’s commitment to publishing high-quality spine research. We hope this commentary will further refine the interpretation of long-term surgical outcomes in patients with lumbar spinal stenosis.
