Abstract
PurposeTo access the feasibility and efficacy of percutaneous endoscopic debridement (PED) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis.MethodsForty-five patients diagnosed as pyogenic spondylodiscitis underwent PPSF followed by PED. A drainage catheter was left in place for negative pressure drainage. Adequate systematic antibiotics were administered empirically or based on bacterial culture results. Clinical outcomes were assessed by physical examination, regular serologic testing, visual analog scale (VAS), Oswestry Disability Index (ODI), and imaging studies.ResultsThe mean operative time was 110.1 ± 21.2 minutes (range 80–165 minutes), with intra-operative blood loss 47.8 ± 21.0 ml (range 20–120 ml). All patients reported relief of back pain, able to sit up, and partially ambulate the next day. Causative pathogens were identified in 32 of 45 biopsy specimens, staphylococcal bacteria being the most prevalent strain. However, there were 13 patients with post-operative complications. During 6–12 months’ follow-up, inflammatory markers showed infection controlled. VAS and ODI values were significantly improved.DiscussionSatisfactory clinical and functional outcomes were achieved in our patients post-operatively. It is recommended that PED plus PPSF can be another alternative for spondylodiscitis.ConclusionPED supplementing PPSF offers a valid option in treating spondylodiscitis, as it is minimally invasive, shortens hospital stay, and avoids prolonged bed rest with an optimistic outcome.
Highlights
Spondylodiscitis is the most commonly seen pyogenic spinal infection that affects intervertebral disc, adjacent vertebrae, Gao Liang-bin contributed to this work.Dept. of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, ChinaDept. of Orthopedics, Zhuhai People’s Hospital, 79 Kangning Road, Zhuhai, ChinaDept. of Orthopedics, Xinsteel Center Hospital, Tuanjie West Road, Xinyu, China and surrounding structures [1]
The surgery consisted of two steps: percutaneous pedicle screw fixation usually prior to percutaneous endoscopic debridement
From January 2014 to December 2016, 45 patients with a mean age of 51.2 ± 14.6 years (6 patients with L1/2 disc infection, 8 with L2/3, 11 with L3/4, 10 with L4/5, 1 with L1–3, 4 with L5/S1, 2 with L2–4, 2 with L3–5, 1 with L4-S1) from three different co-operated hospitals were retrospectively enrolled into the study and subsequently received the percutaneous endoscopic debridement (PED) with percutaneous pedicle screw fixation (PPSF) procedure as described
Summary
Spondylodiscitis is the most commonly seen pyogenic spinal infection that affects intervertebral disc, adjacent vertebrae, Gao Liang-bin contributed to this work.Dept. of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, ChinaDept. of Orthopedics, Zhuhai People’s Hospital, 79 Kangning Road, Zhuhai, ChinaDept. of Orthopedics, Xinsteel Center Hospital, Tuanjie West Road, Xinyu, China and surrounding structures [1]. By the end of nineteenth century, according to Makins and Abbot’s study, the reported death rate of pyogenic spondylitis in children and other young patients could reach 70% [2]. A significant change in the prognosis of the affected children was achieved with the use of antibiotics [3]. Surgical intervention is typically reserved for patients in case of unresponsive antibiotic treatment, severe kyphotic deformity or progressive instability of vertebral column, epidural abscess, and significant neurological deficit [5]. With the progress in surgical techniques and the development of internal fixation implants, active surgical managements reduce hospital stay and avoid prolonged bed rest; its surgical indication broadens for the treatment of pyogenic spondylitis
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