Department of Orthopedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637500, Sichuan, China.
BMC Musculoskelet Disord. 2024 Feb 13;25(1):137. doi: 10.1186/s12891-024-07257-9.
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.
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.
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).
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.
越来越多的证据表明 Modic 改变（MC）与亚临床感染和炎症反应之间存在关联。然而，术前 MC 与手术部位感染（SSI）之间的关系尚未得到充分探讨。本研究旨在探讨 MC 与 SSI 之间的相关性。
对 2018 年至 2023 年在我院行单节段腰椎手术治疗腰痛的 646 例患者（n=646）进行回顾性分析。根据美国疾病控制与预防中心（CDC）的标准，将患者分为 SSI 组（n=40）和非 SSI 组（n=606）。采用单因素分析比较两组间变量的统计学差异，将有显著差异的变量纳入多因素逻辑回归分析，确定 SSI 的独立危险因素。对独立危险因素进行受试者工作特征（ROC）曲线分析。
SSI 组和非 SSI 组在糖尿病患病率、MC 患病率、总终板评分（TEPS）和 MC 面积比方面存在显著差异（P<0.05）。年龄、性别、美国麻醉师协会（ASA）评分、高血压、冠心病（CHD）、慢性阻塞性肺疾病（COPD）、MC 分类以及 MC 在终板的位置无显著差异（P>0.05）。对有显著差异的变量进行多因素二元逻辑回归分析，结果表明 TEPS（P=0.009）和 MC 改变面积比（P=0.001）与 SSI 显著相关。对 TEPS 和 MC 改变面积比进行 ROC 曲线分析，结果显示 TEPS（AUC：0.641；CI：0.522-0.759）的诊断价值低于 MC 改变面积比（AUC：0.722；CI：0.621-0.824），且联合诊断并未显著提高诊断价值（AUC：0.747；CI：0.653-0.842）。MC 改变面积比对于 SSI 具有中等诊断价值（AUC：0.722；CI：0.621-0.824），由约登指数确定的截断值为 24.62%（灵敏度：69.2%；特异性：73.1%），MC 患者的 MC 改变面积比每增加 1%，SSI 的风险增加 10.3%（OR=1.103；CI：1.044-1.167）。
腰椎手术后 MC 和 TEPS 是 SSI 的独立危险因素。MC 改变面积比的预测价值大于 TEPS，两者联合使用时，预测价值无显著提高。当 MC 比例超过 24.62%时，应警惕 SSI 的发生。
