Abstract
BackgroundThe treatment of lumbar infectious spondylitis is controversial. In this study, we attempted to demonstrate that unilateral percutaneous endoscopic debridement with physiologic saline and negative pressure drainage postoperatively may achieve a satisfactory result in lumbar infectious spondylitis.MethodsWe retrospectively analyzed 17 patients with lumbar infectious spondylitis who underwent percutaneous endoscopic debridement and drainage (PEDD) through a posterolateral transforaminal approach. Each biopsy specimen was submitted without delay after surgery and examined for microorganisms and evaluated histopathologically. Patients were assessed by careful physical examination, MacNab criteria, Oswestry Disability Index (ODI), visual analog scale (VAS), regular serological tests, imaging studies for clinical function, and patient satisfaction.ResultsOf the 17 patients, 14 (82.4%) had satisfactory relief of their back pain according to MacNab criteria at 1 week after PEDD. Three patients (17.6%) who had advanced infections with multilevel involvement and paraspinal abscesses underwent anterior debridement and autograft interbody fusion with instrumentation within 2 weeks. However, there were no other severe surgery-related complications. Causative bacteria were identified in most cases, and Staphylococcus aureus was the most prevalent strain.ConclusionsUnilateral PEDD with physiological saline or empirical antibiotics did not disrupt lumbar stability and avoided the important intraspinal structures such as the dural sac and nerve roots. It not only had a high rate of identification of the causative pathogen, but also provided effective infection control and pain relief. PEDD may be a useful technique for treatment of lumbar infectious spondylodiscitis patients who have no severe deformities and are unable to undergo the conventional anterior surgery due to poor health or advanced age.
Highlights
The treatment of lumbar infectious spondylitis is controversial
Our indications for performing percutaneous endoscopic debridement and drainage (PEDD) included (1) intolerable back and/or radiating pain caused by lumbar infectious spondylitis; (2) elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values; and (3) radiographic film and magnetic resonance imaging (MRI) findings, namely, narrowing of the intervertebral disc space and variable degrees of destruction of the adjacent vertebral endplates, disc hyperintensity on T2-weighted MRI imaging
The most prominent clinical sign of infectious spondylitis was back pain, which was detected in all 17 patients before PEDD
Summary
The treatment of lumbar infectious spondylitis is controversial. In this study, we attempted to demonstrate that unilateral percutaneous endoscopic debridement with physiologic saline and negative pressure drainage postoperatively may achieve a satisfactory result in lumbar infectious spondylitis. Infectious spondylitis is usually found in the lumbar spine, which can be divided into pyogenic (the most frequent), non-specific, and specific (such as tuberculosis) types [1] It can spontaneously occur in immunocompromised patients as a result of hematogenous spread from other. The goal of conservative treatment is to wait for natural bone fusion progression into the intervertebral region and achieve pain relief by avoiding activities that can contribute to the gap between the upper and lower lumbar vertebral bodies. This process often takes more than 3 months, which is difficult for patients and their families [8, 9]. Inappropriate open surgery can damage the vulnerable spinal cord and nerve roots, disrupt spinal stability, and even inflict additional trauma on suffering patients
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