Abstract
Introduction Conservative therapy, including appropriate antibiotics and bracing, is usually adequate for most patients with pyogenic spondylodiscitis. If conservative treatment fails, surgical intervention is needed. However, major spinal surgery comprising anterior debridement and accompanying bone grafting with or without additional instrumentation is often related to undesired postoperative complications. In recent years, with minimally invasive surgery, the diagnostic and therapeutic value of endoscopic lavage and drainage has been proven. This study reports a case series of patients who required open revision surgery after treatment with endoscopic surgery using the full endoscopic discectomy system (FED), indicating the surgical limitations of endoscopic surgery for pyogenic spondylodiscitis. Methods We retrospectively investigated the medical records of 4 patients who underwent open debridement and anterior reconstruction with posterior instrumentation following endoscopic surgery for their advanced lumbar infectious spondylitis. They had been receiving conservative treatment with antibiotics for 12–15 days. They also had various comorbidities, including kidney disease, heart failure, and diabetes. Numerical rating scale pain response, perioperative imaging studies, and C-reactive protein (CRP) levels were determined, and causative bacteria were identified. Primarily, the bone destruction stage was classified using computed tomography with reference to Griffiths' scheme. Results All patients had severe back pain before surgery with no relief of the pain after FED. Increased pain, including radicular pain after FED, was noted in one case. Causative pathogens from biopsy specimens were identified in 3 (75%) of the 4 cases. In preoperative radiological evaluation, all cases were classified as destructive stage in Griffiths' scheme. The CRP levels of all the patients decreased slightly after endoscopic surgery. Relapse of spinal infection after revision surgery was not noted in any patient during the follow-up period. Conclusion The surgical treatment of destructive-stage spondylitis with FED alone can increase low back pain due to aggressive debridement.
Highlights
Conservative therapy, including appropriate antibiotics and bracing, is usually adequate for most patients with pyogenic spondylodiscitis
Invasive Surgery e purpose of this study is to report a case series of patients with pyogenic spondylodiscitis that was unsuccessfully treated with endoscopic surgery using the full endoscopic discectomy system (FED)
We retrospectively examined 4 patients (2 males and 2 females; mean age, 70.6 years) with pyogenic lumbar spondylodiscitis who underwent debridement and anterior fusion surgery following FED. e mean follow-up period was 19.5 months (6–26 months). e organisms had been identified in all cases by blood cultures, and patients had been receiving conservative treatment with compatible antibiotics for 12–15 days at the Department of Internal Medicine
Summary
Conservative therapy, including appropriate antibiotics and bracing, is usually adequate for most patients with pyogenic spondylodiscitis. Is study reports a case series of patients who required open revision surgery after treatment with endoscopic surgery using the full endoscopic discectomy system (FED), indicating the surgical limitations of endoscopic surgery for pyogenic spondylodiscitis. E surgical treatment of destructive-stage spondylitis with FED alone can increase low back pain due to aggressive debridement. Several minimally invasive methods, such as computed tomography-guided debridement and drainage, percutaneous discectomy, and procedures involving percutaneous pedicle screws have been used to treat infectious spondylitis [2,3,4,5,6]. Invasive Surgery e purpose of this study is to report a case series of patients with pyogenic spondylodiscitis that was unsuccessfully treated with endoscopic surgery using the full endoscopic discectomy system (FED)
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