Percutaneous Endoscopic Debridement and Drainage for Spinal Infection: Systemic Review and Meta-Analysis

Abstract

Background: Percutaneous endoscopic debridement and drainage (PEDD) has played a vital role in the management of spinal infection; however, limited PEDD results are available to date. Objectives: The purpose of this systematic review is to examine the existing literature, to give an objective estimate of the outcomes of PEDD using a meta-analytical approach. Study Design: Meta-analysis and systematic review of retrospective single-arm studies. Methods: A comprehensive online review was performed in MEDLINE, EMBASE, PubMed, Web of Science, and Cochrane databases from 1980 to October 2018. Eligible studies included the singlearm studies that mentioned PEDD in the management of spinal infection. Pooled event rates for positive bacteria culture, pain control satisfaction, and reoperation were estimated. The complications of PEDD were also recorded. Results: Nine single-arm PEDD articles (158 patients) were included. The pooled event rate was 82% (95% CI: 75%-88%) for positive bacteria culture, 81% (95% CI: 73%-87%) for pain control satisfaction, and 21% (95% CI: 15%-29%) for reoperation. There are few complications reported in the literature that included transient paresthesia in the affected lumbar segment and local kyphosis. Limitations: First, all included studies were retrospective series with inherent methodological limitations. Second, the sample size and the number of studies that were found to be eligible was small. In addition, all included studies are single-arm, and further studies are necessary in large randomized controlled trials on comparing the efficacy of conservative therapy, PEDD, and open surgical intervention. Conclusions: PEDD not only has a high rate of causative-pathogen identification, but also provides satisfactory clinical outcome. Early PEDD intervention in spinal infection is encouraging; however, further studies in large randomized controlled trials on comparing the efficacy of conservative therapy, PEDD, and open surgical intervention are necessary. Key words: Percutaneous endoscopic debridement and drainage, spinal infection, meta-analysis