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

被引：13

作者：

Ninomiya, Ken ^{[1
,10
]}

Fujita, Nobuyuki ^{[2
,10
]}

Hosogane, Naobumi ^{[3
,10
]}

Hikata, Tomohiro ^{[4
,10
]}

Watanabe, Kota ^{[2
,10
]}

Tsuji, Osahiko ^{[2
,10
]}

Nagoshi, Narihito ^{[2
,10
]}

Yagi, Mitsuru ^{[2
,10
]}

Kaneko, Shinjiro ^{[5
,10
]}

Fukui, Yasuyuki ^{[6
,10
]}

Koyanagi, Takahiro ^{[7
,10
]}

Shiraishi, Tateru ^{[1
,10
]}

Tsuji, Takashi ^{[8
,10
]}

Nakamura, Masaya ^{[2
,10
]}

Matsumoto, Morio ^{[2
,10
]}

Ishii, Ken ^{[2
,9
,10
]}

机构：

[1] Ichikawa Gen Hosp, Tokyo Dent Coll, Dept Orthopaed Surg, 5-11-13 Sugano, Ichikawa, Chiba, Japan

[2] Keio Univ, Sch Med, Dept Orthopaed Surg, Shinjyuku Ku, 35 Shinanomachi, Tokyo, Japan

[3] Natl Def Med Sch, Dept Orthopaed Surg, 3-2 Namiki, Tokorozawa, Saitama, Japan

[4] Kitasato Inst Hosp, Dept Orthopaed Surg, Minato Ku, 5-9-1 Shirokane, Tokyo, Japan

[5] Murayama Med Ctr, Dept Orthopaed Surg, 2-37-1 Gakuen, Tokyo, Japan

[6] Int Univ Hlth & Welf, Mita Hosp, Dept Orthopaed Surg, Minato Ku, 1-4-3 Mita, Tokyo, Japan

[7] Kawasaki Municipal Hosp, Dept Orthopaed Surg, Kawasaki Ku, 12-1 Shinkawadouri, Kawasaki, Kanagawa, Japan

[8] Fujita Hlth Univ, Dept Orthopaed Surg, 1-98 Dengakugakubo,Kutsukakecho, Toyoake, Aichi, Japan

[9] Int Univ Hlth & Welf, Sch Med, Dept Orthopaed Surg, 4-3 Kozunomori, Chiba, Japan

[10] KSRG, Shinjyuku Ku, 35 Shinanomachi, Tokyo, Japan

来源：

JOURNAL OF ORTHOPAEDIC SCIENCE | 2017年 / 22卷 / 06期

关键词：

SURGICAL SITE INFECTION; SPINAL SURGERY; VERTEBRAL OSTEOMYELITIS; INTERVERTEBRAL DISC; CLASSIFICATION; SPONDYLITIS; PREVALENCE; BACTERIA; OUTCOMES; FUSION;

D O I：

10.1016/j.jos.2017.07.003

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

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. (C) 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

引用

页码：988 / 993

页数：6

共 37 条

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