Ken Ninomiya1, Nobuyuki Fujita2, Naobumi Hosogane3, Tomohiro Hikata4, Kota Watanabe5, Osahiko Tsuji5, Narihito Nagoshi5, Mitsuru Yagi5, Shinjiro Kaneko6, Yasuyuki Fukui7, Takahiro Koyanagi8, Tateru Shiraishi1, Takashi Tsuji9, Masaya Nakamura5, Morio Matsumoto5, Ken Ishii10. 1. Tokyo Dental College Ichikawa General Hospital, Department of Orthopaedic Surgery, 5-11-13 Sugano, Ichikawa, Chiba, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. 2. Keio University School of Medicine, Department of Orthopaedic Surgery, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. Electronic address: nfujita@a7.keio.jp. 3. National Defense Medical School, Department of Orthopaedic Surgery, 3-2 Namiki, Tokorozawa, Saitama, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. 4. Kitasato Institute Hospital, Department of Orthopaedic Surgery, 5-9-1 Shirokane, Minato-ku, Tokyo, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. 5. Keio University School of Medicine, Department of Orthopaedic Surgery, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. 6. Murayama Medical Center, Department of Orthopaedic Surgery, 2-37-1 Gakuen, Musashimurayama, Tokyo, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. 7. International University of Health and Welfare, Mita Hospital, Department of Orthopaedic Surgery, 1-4-3 Mita, Minato-ku, Tokyo, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. 8. Kawasaki Municipal Hospital, Department of Orthopaedic Surgery, 12-1 Shinkawadouri, Kawasaki-ku, Kawasaki, Kanagawa, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. 9. Fujita Health University, Department of Orthopaedic Surgery, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. 10. Keio University School of Medicine, Department of Orthopaedic Surgery, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan; International University of Health and Welfare, School of Medicine, Department of Orthopaedic Surgery, 4-3 Kozunomori, Narita, Chiba, Japan; Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan. Electronic address: keni8888@z7.keio.jp.
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.
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.
Authors: Dalin Wang; Alon Lai; Jennifer Gansau; Philip Nasser; Yunsoo Lee; Damien M Laudier; James C Iatridis Journal: J Mech Behav Biomed Mater Date: 2022-04-14
Authors: Mark J Lambrechts; Parker Brush; Tariq Z Issa; Gregory R Toci; Jeremy C Heard; Amit Syal; Meghan M Schilken; Jose A Canseco; Christopher K Kepler; Alexander R Vaccaro Journal: Int J Environ Res Public Health Date: 2022-08-16 Impact factor: 4.614