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Updated: Jun 25, 2025
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Association of modic changes and postoperative surgical site infection after posterior lumbar spinal fusion
Siping Deng1, Jiahua Xie1,2, Tianzuo Niu1
1Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
Purpose:
Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies have reported Modic changes (MC) represent a subclinical infection. This study aims to investigate the relation between Modic changes and surgical site infection after posterior lumbar fusion surgery.
Methods:
We retrospectively reviewed the records of 424 patients who received posterior lumbar fusion. Preoperative clinical and radiological parameters were recorded. Primary outcome was the rate of postoperative surgical site infection. Covariates included age, body mass index (BMI), sex, hypertension, diabetes mellitus, chronic heart failure, Pfirrmann classification, fused levels, and operation duration. The presence of Modic changes was used as an exposition variable, and adjusted for other risk factors in multivariate analyses.
Results:
Of the 424 patients, 30 (7%) developed an acute surgical site infection. Infection had no relation to age, sex, BMI, and comorbidities. There were 212 (50%) patients with MC, and 23 (10.8%) had a surgical site infection, compared to 212 (50%) patients without MC in which there were 7 (3.3%) surgical site infections. MC was associated with surgical site infection in univariate analysis (odds ratio [OR] = 3.56, 95% confidence interval [CI]: 1.49-8.50, p = 0.004) and multivariate logistic regression analysis (OR = 3.05, 95% CI: 1.26-7.37, p = 0.013). There was statistically significant between specific type (p = 0.035) and grade of MCs (p = 0.0187) and SSI.
Conclusions:
MCs may be a potential risk factor for SSI following posterior lumbar spinal intervertebral fusion. Type I and grade C MCs showed a higher infection rate compared with other MC types and grades.
Insights
Modic changes (MC) may indicate a higher risk of surgical site infection (SSI) after posterior lumbar fusion. Specifically, Type I and grade C MCs were associated with increased infection rates, suggesting MC as a potential risk factor for SSI.
Area of Science:
- Spine Surgery
- Infectious Diseases
- Radiology
Background:
- Postoperative surgical site infection (SSI) is a significant complication following spine surgery.
- Modic changes (MC) are vertebral endplate abnormalities that may represent subclinical infection.
Purpose of the Study:
- To investigate the association between Modic changes (MC) and the incidence of surgical site infection (SSI) after posterior lumbar fusion.
- To identify specific types and grades of MCs that correlate with increased SSI risk.
Main Methods:
- Retrospective review of 424 patients undergoing posterior lumbar fusion.
- Analysis of preoperative clinical and radiological parameters, including the presence and characteristics of Modic changes.
- Multivariate logistic regression to adjust for potential confounding factors such as age, BMI, and comorbidities.
Main Results:
- The overall incidence of SSI was 7% (30 out of 424 patients).
- Patients with Modic changes (MC) had a significantly higher rate of SSI (10.8%) compared to those without MC (3.3%).
- Modic changes were independently associated with SSI (OR=3.05, p=0.013), with Type I and grade C MCs showing the highest infection rates.
Conclusions:
- Modic changes (MC) may serve as a potential risk factor for surgical site infection (SSI) after posterior lumbar fusion.
- Specific types (Type I) and grades (grade C) of Modic changes are linked to a greater risk of SSI, warranting further investigation and potential clinical consideration.
