J Korean Neurosurg Soc.  2020 Nov;63(6):784-793. 10.3340/jkns.2020.0013.

Change of Pyogenic and Tuberculous Spondylitis between 2007 and 2016 Year : A Nationwide Study

• Kim YJ
• Hong JB
• Kim YS
• Yi J
• Choi JM
• Sohn S

• KMID: 2508609
• DOI: http://doi.org/10.3340/jkns.2020.0013

Abstract

Objective
: We attempted to compare the incidence of pyogenic spondylitis (PS) and tuberculous spondylitis (TS) between 2007 and 2016. Furthermore, we investigated the patients who underwent surgery in 2016 compared to that in 2007.
Methods
: We used a nationwide database managed by the Korean National Health Insurance Service (NHIS) in 2007 and 2016. Total 9655 patients with a newly diagnosis of PS or TS were enrolled in PS or TS group. Among them, 1721 patients underwent either fusion or decompression surgery. We analyzed demographic distribution of patients according to gender and age and year of diagnosis.
Results
: Comparing between 2007 and 2016, the incidence of PS has increased in 2016 than in 2007 (4874 vs. 2431, p<0.0001). Conversely, declination of incidence of TS was discovered in 2016 compared to 2007 (594 vs. 1756, p<0.0001). Females showed predominance over males regarding both PS and TS (5228 vs. 4427, p<0.0001). Among them, the number of PS patients who underwent surgery increased significantly in 2016 relative to that in 2007 (979 vs. 592, p<0.0001).
Conclusion
: This nationwide study suggests that PS may increase and TS may decrease in Korea. In addition, demand for surgery regarding PS may increase.

Keyword

Nationwide study; Pyogenic spondylitis; Tuberculosis, Spinal; Epidemiology; Infectious spondylitis

Figure

• 

  Fig. 1. Flow for establishment of this nationwide study. Among the patients with pyogenic spondylitis (PS) and tuberculous spondylitis (TS) (n=13277), patients with previous diagnosis of the diseases within 1 year was excluded. Subsequently, patients under 20 years old were excluded followed by exclusion of patients diagnosed as both diseases.

• 

  Fig. 2. Comparison of the incidence of PS and TS in 2007 and 2016. A : The incidence of PS was significantly higher in 2016 compared to in 2007. B : The incidence of TS outnumbered in 2007 relative to in 2016 (P<0.0001). PS : pyogenic spondylitis, TS : tuberculous spondylitis.

Reference

References

1. Aagaard T, Roed C, Dragsted C, Skinhøj P. Microbiological and therapeutic challenges in infectious spondylodiscitis: a cohort study of 100 cases, 2006-2011. Scand J Infect Dis. 45:417–424. 2013.

2. Ahn JS, Lee JK. Diagnosis and treatment of tuberclous spondylitis and pyogenic spondylitis in atypical cases. Asian Spine J. 1:75–79. 2007.

3. Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K. Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open. 3:e002412. 2013.

4. Cegielski JP, McMurray DN. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int J Tuberc Lung Dis. 8:286–298. 2004.

5. Cheung WY, Luk KD. Pyogenic spondylitis. Int Orthop. 36:397–404. 2012.

6. Colmenero JD, Jiménez-Mejías ME, Sánchez-Lora FJ, Reguera JM, Palomino-Nicás J, Martos F, et al. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis. 56:709–715. 1997.

7. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect. 56:401–412. 2008.

8. Fantoni M, Trecarichi EM, Rossi B, Mazzotta V, Di Giacomo G, Nasto LA, et al. Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 16 Suppl. 2:2–7. 2012.

9. Forrester DM. Infectious spondylitis. Semin Ultrasound CT MR. 25:461–473. 2004.

10. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 65 Suppl 3:iii11–iii24. 2010.

11. Grammatico L, Baron S, Rusch E, Lepage B, Surer N, Desenclos JC, et al. Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002-2003. Epidemiol Infect. 136:653–660. 2008.

12. Guttmann OP, Rahman MS, O’Mahony C, Anastasakis A, Elliott PM. Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review. Heart. 100:465–472. 2014.

13. Jensen AG, Espersen F, Skinhøj P, Rosdahl VT, Frimodt-Møller N. Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980-1990. J Infect. 34:113–118. 1997.

14. Jeong SJ, Choi SW, Youm JY, Kim HW, Ha HG, Yi JS. Microbiology and epidemiology of infectious spinal disease. J Korean Neurosurg Soc. 56:21–27. 2014.

15. Kehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect. 68:313–320. 2014.

16. Kim CJ, Kim EJ, Song KH, Choe PG, Park WB, Bang JH, et al. Comparison of characteristics of culture-negative pyogenic spondylitis and tuberculous spondylitis: a retrospective study. BMC Infect Dis. 16:560. 2016.

17. Lee DH, Choi YJ, Han IB, Hong JB, Do Han K, Choi JM, et al. Association of ischemic stroke with ankylosing spondylitis: a nationwide longitudinal cohort study. Acta Neurochir (Wien). 160:949–955. 2018.

18. Lee DH, Choi YJ, Han IB, Hong JB, Do Han K, Choi JM, et al. Correction to: Association of ischemic stroke with ankylosing spondylitis: a nationwide longitudinal cohort study. Acta Neurochir (Wien). 160:957–958. 2018.

19. Lee KY. Comparison of pyogenic spondylitis and tuberculous spondylitis. Asian Spine J. 8:216–223. 2014.

20. Lora-Tamayo J, Euba G, Narváez JA, Murillo O, Verdaguer R, Sobrino B, et al. Changing trends in the epidemiology of pyogenic vertebral osteomyelitis: the impact of cases with no microbiologic diagnosis. Semin Arthritis Rheum. 41:247–255. 2011.

21. Noh SH, Zhang HY, Lee SH, Choi JK, Chin DK. Changes in trends of spondylitis in Korea based on a nationwide database. Yonsei Med J. 60:487–489. 2019.

22. Park CJ, Choi YJ, Kim JG, Han IB, Do Han K, Choi JM, et al. Association of acute myocardial infarction with ankylosing spondylitis: a nationwide longitudinal cohort study. J Clin Neurosci. 56:34–37. 2018.

23. Pigrau C, Almirante B, Flores X, Falco V, Rodríguez D, Gasser I, et al. Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med. 118:1287. 2005.

24. Pigrau C, Rodríguez-Pardo D, Fernández-Hidalgo N, Moretó L, Pellise F, Larrosa MN, et al. Health care associated hematogenous pyogenic vertebral osteomyelitis: a severe and potentially preventable infectious disease. Medicine (Baltimore). 94:e365. 2015.

25. Skaf GS, Domloj NT, Fehlings MG, Bouclaous CH, Sabbagh AS, Kanafani ZA, et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health. 3:5–16. 2010.

26. Sohn S, Chung CK, Han KD, Jung JH, Hyeun JH, Kim J, et al. A nationwide study of surgery in a newly diagnosed spine metastasis population. J Korean Neurosurg Soc. 62:46–52. 2019.

27. Sohn S, Chung CK, Jung JH, Lee KC, Kim J, Chang UK, et al. Nationwide comparative study of synchronous and metachronous spine metastasis in the adult Korean population. J Clin Neurosci. 57:33–37. 2018.

28. Sohn S, Kim J, Chung CK, Lee NR, Chang UK, Sohn MJ. A nationwide study of stereotactic radiosurgery in a newly diagnosed spine metastasis population. Stereotact Funct Neurosurg. 95:189–196. 2017.

29. Sohn S, Kim J, Chung CK, Lee NR, Park E, Chang UK, et al. A nationwide epidemiological study of newly diagnosed spine metastasis in the adult Korean population. Spine J. 16:937–945. 2016.

30. Sohn S, Kim J, Chung CK, Lee NR, Park E, Chang UK, et al. Nationwide epidemiology and healthcare utilization of spine tumor patients in the adult Korean population, 2009-2012. Neurooncol Pract. 2:93–100. 2015.

31. Sohn S, Kim J, Chung CK, Lee NR, Sohn MJ, Kim SH. A nation-wide epidemiological study of newly diagnosed primary spine tumor in the adult Korean population, 2009-2011. J Korean Neurosurg Soc. 60:195–204. 2017.

32. Torda AJ, Gottlieb T, Bradbury R. Pyogenic vertebral osteomyelitis: analysis of 20 cases and review. Clin Infect Dis. 20:320–328. 1995.

33. Waldvogel FA, Vasey H. Osteomyelitis: the past decade. N Engl J Med. 303:360–370. 1980.