Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis

Ken Ninomiya, Nobuyuki Fujita, Naobumi Hosogane, Tomohiro Hikata, Kota Watanabe, Osahiko Tsuji, Narihito Nagoshi, Mitsuru Yagi, Shinjiro Kaneko, Yasuyuki Fukui, Takahiro Koyanagi, Tateru Shiraishi, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto, Ken Ishii

Research output: Contribution to journalArticle

Abstract

Study Design Multicenter retrospective study. Background Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies do not appear to have investigated pyogenic discitis following lumbar laminectomy without discectomy. This study aimed to identify risk factors for postoperative pyogenic discitis following lumbar decompression surgery. Methods We examined data from 2721 patients undergoing lumbar laminectomy without discectomy in five hospitals from April 2007 to March 2012. Patients who developed postoperative discitis following laminectomy (Group D) and a 4:1 matched cohort (Group C) were included. Fisher's exact test was used to determine risk factors, with values of p < 0.05 considered statistically significant. Results The cumulative incidence of postoperative discitis was 0.29% (8/2721 patients). All patients in Group D were male, with a mean age of 71.6 ± 7.2 years. Postoperative discitis was at L1/2 in 1 patient, at L3/4 in 3 patients, and at L4/5 in 4 patients. Except for 1 patient with discitis at L1/2, every patient developed discitis at the level of decompression. The associated pathogens were methicillin-resistant Staphylococcus aureus (n = 3, 37.5%), methicillin-susceptible Staphylococcus epidermidis (n = 1, 12.5%), methicillin-sensitive S. aureus (n = 1, 12.5%), and unknown (n = 3, 37.5%). In the analysis of risk factors for postoperative discitis, Group D showed a significantly lower ratio of patients who underwent surgery in the winter and a significantly higher ratio of patients who had Modic type 1 in the lumbar vertebrae compared to Group C. Conclusions Although further prospective studies, in which other preoperative modalities are used for the evaluation, is needed, our data suggest the presence of Modic type 1 as a risk factor for discitis following laminectomy. Latent pyogenic discitis should be carefully ruled out in patients with Modic type 1. If lumbar laminectomy is performed for such patients, more careful observation is necessary to prevent the development of postoperative discitis.

Original languageEnglish
Pages (from-to)988-993
Number of pages6
JournalJournal of Orthopaedic Science
Volume22
Issue number6
DOIs
Publication statusPublished - 01-11-2017

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Discitis
Decompression
Pathologic Constriction
Laminectomy
Diskectomy
Methicillin
Surgical Wound Infection
Lumbar Vertebrae
Staphylococcus epidermidis
Methicillin-Resistant Staphylococcus aureus
Multicenter Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Ninomiya, Ken ; Fujita, Nobuyuki ; Hosogane, Naobumi ; Hikata, Tomohiro ; Watanabe, Kota ; Tsuji, Osahiko ; Nagoshi, Narihito ; Yagi, Mitsuru ; Kaneko, Shinjiro ; Fukui, Yasuyuki ; Koyanagi, Takahiro ; Shiraishi, Tateru ; Tsuji, Takashi ; Nakamura, Masaya ; Matsumoto, Morio ; Ishii, Ken. / Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis. In: Journal of Orthopaedic Science. 2017 ; Vol. 22, No. 6. pp. 988-993.
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title = "Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis",
abstract = "Study Design Multicenter retrospective study. Background Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies do not appear to have investigated pyogenic discitis following lumbar laminectomy without discectomy. This study aimed to identify risk factors for postoperative pyogenic discitis following lumbar decompression surgery. Methods We examined data from 2721 patients undergoing lumbar laminectomy without discectomy in five hospitals from April 2007 to March 2012. Patients who developed postoperative discitis following laminectomy (Group D) and a 4:1 matched cohort (Group C) were included. Fisher's exact test was used to determine risk factors, with values of p < 0.05 considered statistically significant. Results The cumulative incidence of postoperative discitis was 0.29{\%} (8/2721 patients). All patients in Group D were male, with a mean age of 71.6 ± 7.2 years. Postoperative discitis was at L1/2 in 1 patient, at L3/4 in 3 patients, and at L4/5 in 4 patients. Except for 1 patient with discitis at L1/2, every patient developed discitis at the level of decompression. The associated pathogens were methicillin-resistant Staphylococcus aureus (n = 3, 37.5{\%}), methicillin-susceptible Staphylococcus epidermidis (n = 1, 12.5{\%}), methicillin-sensitive S. aureus (n = 1, 12.5{\%}), and unknown (n = 3, 37.5{\%}). In the analysis of risk factors for postoperative discitis, Group D showed a significantly lower ratio of patients who underwent surgery in the winter and a significantly higher ratio of patients who had Modic type 1 in the lumbar vertebrae compared to Group C. Conclusions Although further prospective studies, in which other preoperative modalities are used for the evaluation, is needed, our data suggest the presence of Modic type 1 as a risk factor for discitis following laminectomy. Latent pyogenic discitis should be carefully ruled out in patients with Modic type 1. If lumbar laminectomy is performed for such patients, more careful observation is necessary to prevent the development of postoperative discitis.",
author = "Ken Ninomiya and Nobuyuki Fujita and Naobumi Hosogane and Tomohiro Hikata and Kota Watanabe and Osahiko Tsuji and Narihito Nagoshi and Mitsuru Yagi and Shinjiro Kaneko and Yasuyuki Fukui and Takahiro Koyanagi and Tateru Shiraishi and Takashi Tsuji and Masaya Nakamura and Morio Matsumoto and Ken Ishii",
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Ninomiya, K, Fujita, N, Hosogane, N, Hikata, T, Watanabe, K, Tsuji, O, Nagoshi, N, Yagi, M, Kaneko, S, Fukui, Y, Koyanagi, T, Shiraishi, T, Tsuji, T, Nakamura, M, Matsumoto, M & Ishii, K 2017, 'Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis', Journal of Orthopaedic Science, vol. 22, no. 6, pp. 988-993. https://doi.org/10.1016/j.jos.2017.07.003

Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis. / Ninomiya, Ken; Fujita, Nobuyuki; Hosogane, Naobumi; Hikata, Tomohiro; Watanabe, Kota; Tsuji, Osahiko; Nagoshi, Narihito; Yagi, Mitsuru; Kaneko, Shinjiro; Fukui, Yasuyuki; Koyanagi, Takahiro; Shiraishi, Tateru; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Ishii, Ken.

In: Journal of Orthopaedic Science, Vol. 22, No. 6, 01.11.2017, p. 988-993.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis

AU - Ninomiya, Ken

AU - Fujita, Nobuyuki

AU - Hosogane, Naobumi

AU - Hikata, Tomohiro

AU - Watanabe, Kota

AU - Tsuji, Osahiko

AU - Nagoshi, Narihito

AU - Yagi, Mitsuru

AU - Kaneko, Shinjiro

AU - Fukui, Yasuyuki

AU - Koyanagi, Takahiro

AU - Shiraishi, Tateru

AU - Tsuji, Takashi

AU - Nakamura, Masaya

AU - Matsumoto, Morio

AU - Ishii, Ken

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Study Design Multicenter retrospective study. Background Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies do not appear to have investigated pyogenic discitis following lumbar laminectomy without discectomy. This study aimed to identify risk factors for postoperative pyogenic discitis following lumbar decompression surgery. Methods We examined data from 2721 patients undergoing lumbar laminectomy without discectomy in five hospitals from April 2007 to March 2012. Patients who developed postoperative discitis following laminectomy (Group D) and a 4:1 matched cohort (Group C) were included. Fisher's exact test was used to determine risk factors, with values of p < 0.05 considered statistically significant. Results The cumulative incidence of postoperative discitis was 0.29% (8/2721 patients). All patients in Group D were male, with a mean age of 71.6 ± 7.2 years. Postoperative discitis was at L1/2 in 1 patient, at L3/4 in 3 patients, and at L4/5 in 4 patients. Except for 1 patient with discitis at L1/2, every patient developed discitis at the level of decompression. The associated pathogens were methicillin-resistant Staphylococcus aureus (n = 3, 37.5%), methicillin-susceptible Staphylococcus epidermidis (n = 1, 12.5%), methicillin-sensitive S. aureus (n = 1, 12.5%), and unknown (n = 3, 37.5%). In the analysis of risk factors for postoperative discitis, Group D showed a significantly lower ratio of patients who underwent surgery in the winter and a significantly higher ratio of patients who had Modic type 1 in the lumbar vertebrae compared to Group C. Conclusions Although further prospective studies, in which other preoperative modalities are used for the evaluation, is needed, our data suggest the presence of Modic type 1 as a risk factor for discitis following laminectomy. Latent pyogenic discitis should be carefully ruled out in patients with Modic type 1. If lumbar laminectomy is performed for such patients, more careful observation is necessary to prevent the development of postoperative discitis.

AB - Study Design Multicenter retrospective study. Background Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies do not appear to have investigated pyogenic discitis following lumbar laminectomy without discectomy. This study aimed to identify risk factors for postoperative pyogenic discitis following lumbar decompression surgery. Methods We examined data from 2721 patients undergoing lumbar laminectomy without discectomy in five hospitals from April 2007 to March 2012. Patients who developed postoperative discitis following laminectomy (Group D) and a 4:1 matched cohort (Group C) were included. Fisher's exact test was used to determine risk factors, with values of p < 0.05 considered statistically significant. Results The cumulative incidence of postoperative discitis was 0.29% (8/2721 patients). All patients in Group D were male, with a mean age of 71.6 ± 7.2 years. Postoperative discitis was at L1/2 in 1 patient, at L3/4 in 3 patients, and at L4/5 in 4 patients. Except for 1 patient with discitis at L1/2, every patient developed discitis at the level of decompression. The associated pathogens were methicillin-resistant Staphylococcus aureus (n = 3, 37.5%), methicillin-susceptible Staphylococcus epidermidis (n = 1, 12.5%), methicillin-sensitive S. aureus (n = 1, 12.5%), and unknown (n = 3, 37.5%). In the analysis of risk factors for postoperative discitis, Group D showed a significantly lower ratio of patients who underwent surgery in the winter and a significantly higher ratio of patients who had Modic type 1 in the lumbar vertebrae compared to Group C. Conclusions Although further prospective studies, in which other preoperative modalities are used for the evaluation, is needed, our data suggest the presence of Modic type 1 as a risk factor for discitis following laminectomy. Latent pyogenic discitis should be carefully ruled out in patients with Modic type 1. If lumbar laminectomy is performed for such patients, more careful observation is necessary to prevent the development of postoperative discitis.

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