Inamdar Anupam Pradip, Soundararajan Dilip Chand Raja, Shanmuganathan Rajasekaran, K.S. Sri Vijayanand, Ajoy Prasad Shetty, Rishi Mugesh Kanna, Pushpa Bhari Thippeswamy

June 2021, Volume 30, Issue 6, pp 1732 - 1743 Original Article Read Full Article 10.1007/s00586-020-06581-7

First Online: 05 September 2020


There is increasing evidence of an association between Modic changes (MC) and subclinical infection. However, the association of MC with postoperative surgical site infection (SSI) has not been adequately probed. This study primarily aimed to investigate a probable association between preoperative MC, total endplate damage score (TEPS), and SSI.


A retrospective analysis of 1124 patients who underwent surgery in a single institution (2016–2018) was performed, using both univariate and multiple logistic regression analyses to identify independent risk factors for SSI.


The prevalence of SSI was 4% (44/1124 patients), with no association with age or sex. The prevalence of MC in the SSI group was significantly higher—79.54% (35/44) compared to 58.79% (635/1080) (p value = 0.006) in the control group with no specific relation to type or location of MC. A higher TEPS was associated with SSI (p value = 0.009). A receiver operating characteristic (ROC) curve for TEPS values to assess predictiveness of SSI showed TEPS ≥ 5.5 to have a better sensitivity of 84% than 72% for a TEPS ≥ 6.5. Univariate analysis showed TEPS > 6 (odds ratio 3.887) to have a stronger association with SSI than the presence of MC (odds ratio 2.725). Among various types of surgeries, discectomy had a higher association with SSI (p value = 0.03) when compared to fusion (p value = 0.071). However, multiple logistic regression analysis revealed only TEPS > 6, presence of MC and hypothyroidism as independent risk factors for SSI.


Our data suggest that preoperative MC and TEPS > 6 are independent risk factors for developing surgical site infections. MC could be foci of chronic subclinical infection and not mere markers of degeneration, as initially described.

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