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The area ratio of Modic changes has predictive value for postoperative surgical site infection in lumbar spine
Yanhang Liu1, Qian Chen1, Yueran Wang1
1Department of Orthopedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637500, Sichuan, China.
Background:
Increasing evidence suggests an association between Modic changes (MC) and subclinical infection and inflammatory reactions. However, the relationship between preoperative MC and surgical site infection (SSI) has not been fully explored. This study aims to investigate the correlation between MC and SSI.
Methods:
A retrospective analysis was conducted on patients (n = 646) who underwent single-level lumbar spine surgery for lower back pain in our hospital between 2018 and 2023. According to the Centers for Disease Control and Prevention (CDC) criteria, the patients were divided into an SSI group (n = 40) and a Non-SSI group (n = 606). Univariate analysis was performed to determine the statistical differences in variables between the two groups, and the variables with significant differences were included in a multivariable logistic regression analysis to identify independent risk factors for SSI. Receiver operating characteristic (ROC) curve analysis was performed on the independent risk factors.
Results:
The SSI group and the Non-SSI group exhibited significant differences in diabetes prevalence, MC prevalence, Total endplate score (TEPS) and area ratio of MC (P < 0.05). Age, gender, American Society of Anesthesiologists(ASA)score, hypertension, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), MC classification, and the location of MC in the endplate showed no significant differences (P > 0.05). Multivariate binary logistic regression analysis was performed on the variables with significant differences, and the results indicated a significant correlation between TEPS (P = 0.009) and the area ratio of MC changes (P = 0.001) with SSI. ROC curve analysis was performed on the TEPS and area ratio of MC changes, and the results showed that the diagnostic value of TEPS (AUC: 0.641; CI: 0.522-0.759) is lower than the area ratio of MC (AUC: 0.722; CI: 0.621-0.824), and the combined diagnosis did not significantly improve the diagnostic value (AUC: 0.747; CI: 0.653-0.842). The area ratio of MC had moderate diagnostic value for SSI (AUC: 0.722; CI: 0.621-0.824), with a cut-off value of 24.62% determined by the Youden index (sensitivity: 69.2%; specificity: 73.1%), and for every 1% increase in the area ratio of MC changes, the risk of SSI in MC patients increased by 10.3% (OR = 1.103; CI: 1.044-1.167).
Conclusion:
The area ratio MC and the TEPS are independent risk factors for SSI after lumbar spine surgery. The predictive value of the area ratio of MC is greater than TEPS, and when the two are combined, the predictive value is not significantly improved. When the rate of MC exceeds 24.62%, caution should be exercised regarding the occurrence of SSI.
Insights
Modic changes (MC) are linked to surgical site infections (SSI) after lumbar spine surgery. A higher MC area ratio predicts SSI risk, especially above 24.62%.
Area of Science:
- Spine surgery outcomes
- Infectious disease research
- Radiology and imaging analysis
Background:
- Modic changes (MC) are associated with subclinical infection and inflammation.
- The link between preoperative MC and surgical site infection (SSI) requires further investigation.
Purpose of the Study:
- To investigate the correlation between Modic changes (MC) and surgical site infection (SSI) after single-level lumbar spine surgery.
Main Methods:
- Retrospective analysis of 646 patients undergoing lumbar spine surgery.
- Comparison of SSI and Non-SSI groups using univariate and multivariable logistic regression.
- Receiver operating characteristic (ROC) curve analysis to assess diagnostic value.
Main Results:
- Significant differences in MC prevalence, Total endplate score (TEPS), and MC area ratio between SSI and Non-SSI groups.
- MC area ratio (P=0.001) and TEPS (P=0.009) are independent risk factors for SSI.
- MC area ratio demonstrated moderate diagnostic value for SSI (AUC: 0.722), with a cut-off of 24.62%.
Conclusions:
- MC area ratio and TEPS are independent predictors of SSI following lumbar spine surgery.
- MC area ratio has a greater predictive value for SSI than TEPS.
- Patients with MC area ratio exceeding 24.62% require increased caution for SSI development.
