Percutaneous Endoscopic Debridement Research Articles

Minimally Invasive versus Traditional Surgery: Efficacy of PELD and PLIF in Treating Pyogenic Spondylodiscitis.

BACKGROUND Pyogenic spondylodiscitis is infection of the intervertebral disc or discs and the adjacent vertebrae. This retrospective study aimed to compare the effectiveness of percutaneous endoscopic lumbar debridement (PELD) versus posterior lumbar interbody fusion (PLIF) in 40 patients with pyogenic spondylodiscitis (PSD). MATERIAL AND METHODS Medical records of patients who underwent PELD (n=18) or PLIF (n=22) for PSD between 2018 and 2023 were reviewed. The recorded outcomes encompassed surgical duration, intraoperative blood loss, Oswestry Disability Index (ODI) measurements, Visual Analog Scale (VAS) assessments, C-reactive protein (CRP) levels, duration of hospitalization, erythrocyte sedimentation rate (ESR), American Spinal Injury Association (ASIA) grading, lumbar sagittal parameters, and the incidence of complications. RESULTS The PELD group had shorter surgical duration, less intraoperative blood loss, and shorter length of hospital stay compared to the PLIF group (P<0.01). At the last follow-up, both groups had significant improvement in ESR, CRP levels, and ASIA classification (P<0.001), but there was no significant difference between the 2 groups (P>0.05). The PELD group had lower ODI and VAS ratings at 1 month and 3 months, respectively (P<0.01). The PLIF group had significant improvements in intervertebral space height and lumbar lordosis angle (P<0.01). CONCLUSIONS Both PLIF and PELD surgical approaches demonstrate adequate clinical efficacy in the treatment of monosegmental PSD. PLIF can better ensure more spinal stability than PELD, but PELD offers advantages such as reduced minimal surgical trauma, shorter operative duration, and faster recovery after surgery.

Comparison of CT-Guided needle biopsy versus percutaneous endoscopic debridement and drainage in pathogen identification and pain outcomes for spondylodiscitis patients: A systematic review and literature review

IntroductionSpondylodiscitis (SD) is an infection of the intervertebral disc with involvement of the adjacent vertebral bodies. Diagnostic tests with CT-guided biopsy only provide a positive yield in 14%–48% of cases. Percutaneous endoscopic debridement and drainage (PEDD) has recently shown promise in the treatment of spondylodiscitis. Research questionThe purpose of this study is to determine differences in pathogen identification and clinical outcomes for PEDD versus CT-guided needle biopsy in SD patients. Materials and methodsWe conducted a systematic review of the literature using PRISMA guidelines to determine differences in positive microbiology results, perioperative complications, pain control, and long-term clinical outcomes for PEDD vs. CT-guided needle biopsy in SD patients. Results1078 studies were evaluated, 87 of which underwent full review. 15 studies met the inclusion and exclusion criteria, including 7 PEDD, 7 CT-guided biopsy, and 1 CT-guided biopsy vs. PEDD article, for a total of 192 PEDD patients and 604 CT-guided biopsy patients. We found 36.59% of CT-guided biopsy patients had positive microbiology results, compared to 84.38% of PEDD patients. No major perioperative complications occurred as a result of the PEDD procedure. Of the five PEDD studies that reported pain outcomes, greater than 80% of patients experienced relief after intervention. Discussion and conclusionThese results suggest that PEDD may improve pathogen identification while simultaneously reducing pain compared to CT-guided needle biopsy in SD. Although current treatment guidelines recommend CT-guided biopsy, in patients with severe back pain and suspected SD, PEDD can be considered an alternative intervention.

Retracted: The Percutaneous Endoscopic Lumbar Debridement and Irrigation Drainage Technique for the First-Stage Treatment of Spontaneous Lumbar Spondylodiscitis: A Clinical Retrospective Study.

[This retracts the article DOI: 10.1155/2022/6241818.].

A comprehensive clinical analysis of the use of percutaneous endoscopic debridement for the treatment of early lumbar epidural abscesses.

The purpose of this study is to evaluate the safety and efficacy of a percutaneous endoscopic debridement and drainage for lumbar infections with early epidural abscesses. Eight cases of early epidural abscess underwent lumbar intervertebral space debridement and drainage by percutaneous endoscopic. Laboratory indicators, pathogenic microorganisms and complications were documented, and the ASIA scores were used to assess preoperative and postoperative neurological function changes. Additionally, the VAS was used to evaluate the therapeutic effect. The average duration of the drainage tube was 11.25 ± 3.96 days (7-20 days), and the epidural abscess was eliminated after the tube was taken out. Postoperative CRP (14.40 ± 12.50 mg/L) and ESR (48.37 ± 16.05 mm/1 h) were significantly lower than the preoperative CRP (62.5 ± 61.1 mg/L) and ESR (75.30 ± 26.20 mm/1 h). The VAS score after the operation (2.50 ± 0.92 points) was significantly lower than the one before the surgery (8.25 ± 0.83 points). 5 patients experienced lower extremity pain and neurological dysfunction prior to surgery, however, after drainage, the lower extremity pain dissipated and the lower extremity muscle strength improved in one patient. All 8 patients were followed up for a period of (28.13 ± 10.15) months, including 3 patients with spinal segmental instability who had lumbar bone graft and internal fixation for the second stage. At the end of the follow-up, all 8 patients were clinically cured without any progressive nerve injury, paraplegia or recurrence of infection. Percutaneous Endoscopic Debridement and Drainage is an effective way to drain intraspinal abscesses, thus avoiding any potential progressive harm to the spinal cord.

Diagnosis, severity stratification and management of adult acute pancreatitis-current evidence and controversies.

Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe with an unpredictable natural course. Majority of cases (80%) are mild and self-limiting. However, severe AP (SAP) has a mortality risk of up to 30%. Establishing aetiology and risk stratification are essential pillars of clinical care. Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause. Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence. In SAP, patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit. Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP. Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition. If unable to tolerate per-orally, nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit. Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis. Delayed step-up strategy including percutaneous retroperitoneal drainage, endoscopic debridement, or minimal-access necrosectomy are sufficient in most SAP patients. Patients should be monitored for diabetes mellitus and pseudocyst.

The Percutaneous Endoscopic Lumbar Debridement and Irrigation Drainage Technique for the First-Stage Treatment of Spontaneous Lumbar Spondylodiscitis: A Clinical Retrospective Study.

Background Minimally invasive or open surgery is contentious in the treatment of spondylodiscitis, therefore finding a balance between the two is urgently needed. In this study, we propose a new treatment paradigm for treating spontaneous lumbar spondylodiscitis by percutaneous endoscopic lumbar debridement and irrigation drainage (PELDID). Then, the Pola classification was used to guide subsequent treatment. Methods From November 2017 to April 2019, this study collected data on 16 patients with lumbar spondylodiscitis who were surgically treated utilizing this treatment paradigm in our department. Clinical effectiveness was determined using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), the MOS 36-item short-form health survey (SF-36), and Kirkaldy-Willis criteria. Results All 16 patients completed the treatment using the above paradigm and were followed up for 28.13 ± 10.15 months. The preoperative Pola classification is as follows: 7 cases of type A, 3 cases of type B, and 6 cases of type C. After the first-stage surgery, the evaluation results of Pola classification were as follows: 8 cases of type A, 8 cases of type B, and 0 cases of type C. Four patients received second-stage surgery with internal fixation through the paravertebral multifidus space approach and intervertebral bone graft fusion through the transforaminal approach, and the reoperation rate was 25% (4/16 cases). The Visual analogue scale (VAS), Oswestry Disability Index (ODI), and SF-36 score all improved significantly from 2.43 ± 0.89 to 0.18 ± 0.40, from 77.31% ± 11.15%to 16.93% ± 5.45%, and from 18.34 ± 7.47 to 80.3 ± 15.36. The CRP and ESR decreased dramatically from 49.61 ± 48.84 to12.50 ± 12.18 and from 65.56 ± 26.89 to 29.68 ± 20.68. There were no recurrences of infection in our study. Conclusions The paradigm of the first-stage PELDID technique combined with the Pola classification system to guide the second-stage treatment for spontaneous spondylodiscitis is a novel and effective strategy for treating spontaneous spondylodiscitis.

Percutaneous Endoscopic Interbody Debridement and Fusion (PEIDF) Decreases Risk of Sepsis and Mortality in Treating Infectious Spondylodiscitis for Patients with Poor Physical Status, a Retrospective Cohort Study.

Background: Postoperative immunosuppression is associated with blood loss and surgical trauma during surgery and subsequently predisposes patients to increased morbidity. Spine endoscopic surgery has been accepted as an effective surgical technique with less surgical trauma and less blood loss for the complication of infectious spondylodiscitis. Therefore, the aim of this study was to investigate whether PEIDF could reduce the morbidity rates for patients with infectious spondylodiscitis. Methods: We launched a retrospective cohort study on the comparison of the perioperative prognosis between PEIDF and conventional open surgery for single-level lumbar infectious spondylodiscitis in patients with poor physical health (ASA ≥ 4) from 2014 to 2019. Results: Forty-four patients were included in this study. Fifteen of them underwent PEIDF, and the rest of the 29 patients were treated with open surgery. Less surgical blood loss (p < 0.001) and intraoperative transfusions (p < 0.001) with a better decline of CRP (p = 0.017) were statistically significant in patients receiving PEIDF. Patients undergoing conventional open surgery encountered more postoperative sepsis (p = 0.030), a higher qSOFA score (p = 0.044), and prolonged-time for CRP normalization (p = 0.001). Conclusions: PEIDF minimizes a poor postoperative outcome due to less surgical trauma, intraoperative blood loss, and the need for a blood transfusion.

Percutaneous Transforaminal Endoscopic Debridement and Drainage with Accurate Pathogen Detection for Infectious Spondylitis of the Thoracolumbar and Lumbar Spine

In this study, we aimed to analyze the clinical outcomes of percutaneous transforaminal endoscopic debridement and drainage (PTEDD) with accurate pathogen detection for patients with infectious spondylitis of the thoracolumbar and lumbar spines. From January 2017 to February 2019, a consecutive series of 43 patients with infectious spondylitis of the thoracolumbar and lumbar spine were surgically treated with PTEDD. Organism culture, next-generation DNA sequencing, and pathological examination of the sample extracted from the infectious site were performed for accurate microbiological diagnosis. All patients were followed up for 24-36months. Clinical and radiological outcomes were analyzed preoperatively and postoperatively. Surgeries were completed successfully on all 43 patients under local infiltration anesthesia. Positive culture of the responsible organism was obtained in 33 cases (76.7%). Among the 43 patients who underwent next-generation DNA sequencing, 42 (97.7%) had positive results. Corresponding antibiotic medication was given based on the pathogen detection. The modified Macnab criteria were found to be excellent in 32 patients (74.4%) and good in 11 (25.6%). Postoperative magnetic resonance imaging showed that the abscess and infectious area were reduced significantly at 3months and had disappeared or almost disappeared at the final follow-up. Spontaneous fusion was obtained in 30 patients (69.8%). No patients required revision or conversion to open debridement and reconstruction. For patients with infectious spondylitis of the thoracolumbar and lumbar spine, PTEDD is an effective and safe treatment. Next-generation DNA sequencing is a much more sensitive method for detecting the responsible organisms.

LATEST ADVANCES IN MINIMALLY INVASIVE SPINE SURGERY FOR TREATMENT OF INFECTIOUS SPONDYLITIS

Nowadays, minimal invasive surgery (MIS) plays an important role in the treatment of infectious spondylitis. This paper reviews the current options in MIS techniques and discusses the surgical outcomes from a series of cases at our department. Demographic characteristics and pre-operative clinical status of 21 patients with MIS for multilevel infectious spondylitis were analyzed; also, pre- and post-operative X-rays were assessed for surgical correction angles and fusion status. The results indicated that percutaneous endoscopic debridement (PEDD) and drainage has the advantages of less blood loss and shorter recovery time. Overall, percutaneous screw system can preserve paravertebral soft tissue, reduce post-operative pain, and foster early post-operative mobilization. Robot-assisted percutaneous screw placement is more accurate than using free-hand. Cortical bone trajectory (CBT) screw requires less surgical exposure while preserving adequate strength. Endoscopic lumbar interbody fusion (Endo-LIF) is an alternative fusion technique to treat spondylitis because it offers better functional prognosis than minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of degenerative lumbar diseases. All the enrolled patients via MIS-TLIF obtained good surgical outcomes. Various minimally invasive techniques have been evolved and modified, so it is important for spine surgeon to keep up to date with advanced orthopedic knowledge and surgical techniques.

A case report of percutaneous endoscopic debridement for treating lumbar tuberculous spondylitis with large psoas abscess.

Introduction and importanceSpondylitis tuberculosis is a spinal infection characterized by bone destruction, fracture, abscess, and resulting in deformity (kyphosis and gibbus formation). Therefore, early diagnosis and management of spondylitis tuberculosis have special importance in preventing complications. Surgery is reserved for progressive deformity or where the neurological deficit is not improved by anti-tubercular treatment. The spine can be approached anteriorly or posteriorly in a minimally invasive way. We reviewed the evaluation of clinical outcome, laboratory findings, and radiological post-minimal invasive endoscopic debridement in spinal tuberculosis with psoas abscess.Case presentationWe collected data from two patients, a 24 years-old female and 27 years-old male, who was diagnosed with spondylitis tuberculosis with psoas abscess based on the history, physical, and supportive examination. Patients were given chemotherapy antituberculosis agents and performed percutaneous endoscopic debridement. The outcome was measured by clinical signs, laboratory findings, and radiology evaluation.DiscussionPatients had pre-operative symptoms of unremitting lower back and thigh pain, febrile sensation, signs of paravertebral muscle tenderness, and limitation of spine motion. Post percutaneous endoscopic debridement, patients showed good response with clinical improvement seen from significant reduction of pain, paravertebral muscle tenderness, increasing spinal motion, laboratory improvement with a decline of ESR and CRP value, and radiology findings improvement with resorption of psoas abscess. No complications were found.ConclusionTreatment of spondylitis tuberculosis remains controversial regarding optimal use of antituberculosis drugs and the approach used for surgical decompression. Patients had immediate pain relief and reduced disability in treating spinal tuberculosis after percutaneous endoscopic debridement.

Novel minimally invasive management of lumbar osteomyelitis: A case report.

Introduction and importanceVertebral osteomyelitis is a rare disease that might lead to significant clinical problems. Initially, conservative therapy is considered to be sufficient for most patients. However, it is not uncommon that the infectious process may become fulminant and severe complications could arise. Recent studies have shown that percutaneous endoscopic debridement provides a favorable outcome in managing lumbar infections without severe neurological symptoms.Case presentationWe presented a case report of a female, 49 years old, with pyogenic vertebral osteomyelitis of the 4th - 5th lumbar spine without neurologic deficit. X-ray examination showed a resemblance of the lytic lesion over the anterior aspect of the L4. We then planned a minimally invasive endoscopic procedure for the patient. We made the 1st portal to aspirate the abscess product and for the endoscopy instrument to debride the remaining debris material. We also developed the second portal using kyphoplasty needl towards the pedicle to gain access to the vertebral body. The debriding process was achieved by positive irrigation pressure from one portal to another using physiologic NaCl saline and gentamicin solution.Clinical discussionCombined with the access created by the kyphoplasty needle, more thorough irrigation was made possible as the intravertebral body was approachable. Compared to open surgery, this approach can reduce surgical damage. Clinically, patient experienced an almost instant relief of pain.ConclusionPercutaneous endoscopic debridement technique in addition of kyphoplasty needle allows wider area for adequate debridement and better result, while maintaining minimally invasive setting with minimum complications.

Percutaneous Endoscopic Interbody Debridement and Fusion for Pyogenic Lumbar Spondylodiskitis: Surgical Technique and the Comparison With Percutaneous Endoscopic Drainage and Debridement.

ObjectiveSurgical treatment of severe infectious spondylodiskitis remains challenging. Although minimally invasive percutaneous endoscopic drainage and debridement (PEDD) may yield good results in complicated cases, outcomes of patients with extensive structural damage and mechanical instability may be unsatisfactory. To address severe infectious spondylodiskitis, we have developed a surgical technique called percutaneous endoscopic interbody debridement and fusion (PEIDF), which comprises endoscopic debridement, bonegraft interbody fusion, and percutaneous posterior instrumentation. MethodsOutcomes of PEIDF in 12 patients and PEDD in 15 patients with infectious spondylodiskitis from April 2014 to July 2018 were reviewed retrospectively. Outcome were compared between 2 kinds of surgical procedures. ResultsPatients in PEIDF group had significantly lower rate of revision surgery (8.3% vs. 58.3%), better kyphosis angle (-5.73°±8.74 vs. 1.07°±2.70 in postoperative; 7.09°±7.23 vs. 0.79°±4.08 in kyphosis correction at 1 year), and higher fusion rate (83.3% vs. 46.7%) than those who received PEDD. ConclusionPEIDF is an effective approach for treating infectious spondylodiskitis, especially in patients with spinal instability and multiple medical comorbidities.

Outcome of one-stage percutaneous endoscopic debridement and lavage combined with percutaneous pedicle screw fixation for lumbar pyogenic spondylodiscitis.

This study assessed the therapeutic effect of one-stage percutaneous endoscopic debridement and lavage (PEDL) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis. From March 2017 to October 2019, 51 patients diagnosed with pyogenic spondylodiscitis underwent PPSF followed by PEDL in our department. Biopsy specimens were examined for microorganisms and evaluated histopathologically. Clinical outcomes were assessed by physical examination, routine serological testing, visual analogue scale (VAS), Oswestry Disability Index (ODI) and imaging studies. Of the enrolled patients, the operation time ranged from 90 min to 114 min every level with an average of 102 min, and the average drainage time ranged from 6 days to 10 days with an average of 7.4 days. All patients who complained of lower back pain symptoms were more relieved than before surgery. Causative pathogens were identified in 20 of 51 biopsy specimens; Staphylococcus aureus was the most prevalent. However, there were eight patients with postoperative complications. The mean follow-up was 25.0 ± 3.8 (range: 20-32) months. Inflammatory markers showed that infection was controlled. The VAS and ODI improved significantly. At the last follow-up, magnetic resonance imaging showed that the infected lesions had disappeared. PEDL supplementing PPSF may be useful for patients with single-level lumbar pyogenic spondylodiscitis, as it is minimally invasive, especially for patients who cannot undergo conventional open surgery due to poor health or advanced age.

Clinical application of percutaneous spinal endoscopy debridement and lavage in sacroiliac joint tuberculosis

To investigate the feasibility and clinical efficacy of percutaneous spinal endoscopic debridement and lavage for the treatment of sacroiliac joint tuberculosis. The clinical data of 7 patients with sacroiliac joint tuberculosis treated with percutaneous spinal endoscopic debridement and lavage from January 2007 to April 2009 were retrospectively analyzed. There were 2 males and 5 females, aged from 29 to 69 years old, 4 cases on the right side of the lesion and 3 cases on the left side. The course ranged from 8 to 144 months. According to Kim classification, 5 cases were type Ⅲ and 2 cases were type Ⅳ. All patients were treated with HRZE quadruple anti tuberculosis drugs for 2 to 6 weeks beforeoperation. VAS, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Oswestry Disability Index (ODI) were compared before and after surgery. All the operations were successful, the intraoperative blood loss was less than 50 ml on average, and no complications such as hematoma and infection were occurred. The follow-up time of 7 cases ranged from 18 to 40 months. Pain relief was obvious, and there was a statistical result in the VAS, ESR, and ODI of the patients at 1, 3, 6, 12, 18 months after operation compared with before treatment. At the final follow-up, the patient's clinical, imaging and laboratory examinations showed that the infection had disappeared, and the patient returned to normal life and work. Percutaneous spine endoscopic debridement and lavage has less tissue trauma, targeted operation, definite curative effects, and quick postoperative recovery, which has explored new options for minimally invasive treatment of sacroiliac joint tuberculosis.

Unilateral or Bilateral Percutaneous Endoscopic Debridement and Lavage Treatment for Lumbar Spinal Tuberculosis

To compare the clinical outcome between bilateral percutaneous endoscopic debridement and lavage (PEDL) and unilateral PEDL treatment for lumbar spine tuberculosis (LST). A total of 40 patients with LST who underwent either bilateral PEDL (group A) or unilateral PEDL (group B) were reviewed. Perioperative parameters were assessed by operative time, intraoperative fluoroscopy times, and days of postoperative continuous irrigation and vacuum drainage. Clinical outcomes were evaluated in the Oswestry Disability Index (ODI), visual analog scale (VAS), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). All patients were followed-up for at least 18months after treatment. The average operative time and intraoperative fluoroscopy time were increased in group A compared with those in group B. There was no statistical significance between the 2 groups in postoperative continuous irrigation and vacuum drainage days. The ESR and CRP curves in the 2 groups showed a similar trend during 18-month follow-up. The VAS and ODI in the 2 groups significantly decreased 6 and 18 months postsurgery. There was no significant difference in the incidence of complication between the 2 groups. Two procedures yielded comparable and satisfactory results. Unilateral PEDL showed shorter operative time and decreased intraoperative fluoroscopy times compared with bilateral PEDL. We suggest the use of unilateral PEDL rather than bilateral PEDL in the treatment of LST.

Treatment of lavage drainage under spinal endoscopy on lumbar spinal tuberculosis with vertebral lesions

To investigate the efficacy and safety of the treatment of percutaneous endoscopic debridement (PED) and continuous lavage drainage (CLD) on lumbar tuberculosis. Total 31 patients diagnosed with lumbar tuberculosis, who underwent the PED and CLD from January 2012 to January 2018 in our hospital were included. The operation time, intraoperative blood loss, complications were analyzed. The recovery of local tuberculosis was evaluated by erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and visual analogue scale (VAS) before and after operation. The patients were followed up for 18 to 84 months. At the last follow-up, lumbar lordosis (LL), the Japanese Orthopaedic Association (JOA) score and imaging data were used to evaluate the recovery of spinal structure and function. There were no complications for all patients. During the follow-up of 3 to 12 months after operation, ESR and CRP returned to normal. The VAS score of local pain was significantly lower than that before operation ( p &lt; 0.05). The LL and JOA scores of the patients at the last follow-up were significantly better than those before operation ( p &lt; 0.05), and the lumbar CT and MR suggested the healing of vertebral lesions. PED and CLD might be an effective surgical treatment for spinal tuberculosis.

Percutaneous endoscopic debridement with percutaneous pedicle screw fixation for lumbar pyogenic spondylodiscitis: a preliminary study

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.

Comparison of Percutaneous Endoscopic Surgery and Traditional Anterior Open Surgery for Treating Lumbar Infectious Spondylitis.

Minimally invasive surgery is becoming popular for treating spinal disorders. The advantages of percutaneous endoscopic debridement and drainage (PEDD) for infectious spondylitis include direct observation of the lesion, direct pus drainage, and earlier pain relief. We retrospectively reviewed 37 patients who underwent PEDD and 31 who underwent traditional anterior open debridement and interbody fusion with bone grafting from 2004 to 2012. The causative organisms were isolated from 30 patients (81.1%) following PEDD, and from 25 patients (80.6%) following open surgery (p = 0.48). Staphylococcus aureus was the most common pathogen (38.2%). In the PEDD group, blood loss (<50 mL versus 585 ± 428 mL, p < 0.001) was significantly lesser and the duration of hospitalization (24.4 ± 12.5 days versus 31.5 ± 14.6 days, p = 0.03) was shorter than that in the open surgery group. Serologically, there were significantly faster C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) normalization rates in the PEDD group (p < 0.001, p = 0.009, respectively). In the two-year follow-up radiographs, 26 out of 30 (86.7%) open surgery patients showed bony fusions of the infected segments. On the contrary, sclerotic change of the destructive endplates was observed and the motion of infected spinal segments was still preserved in the PEDD group. There was no significant difference in the change of sagittal profile, including primary correction gain, correction loss, and actual correction gain/loss. PEDD is an effective alternative option and should be considered prior to traditional extensive spinal surgery—particularly for patients with early-stage spinal infection or serious complicated medical conditions.

Percutaneous endoscopic debridement and drainage for the treatment of instrumented lumbar spine infection.

The purpose of this study is to evaluate the efficacy of percutaneous endoscopic debridement and drainage (PEDD) in patients with surgical site infection (SSI) following instrumented lumbar fusion. We retrospectively reviewed the medical records of 20 patients (6 women and 14 men; average age, 60.1 years) who underwent PEDD at our institute to treat SSI following instrumented lumbar fusion from January 2010 to December 2015. The terminal event, or failure of PEDD treatment, was defined as a shift in treatment methods to open surgery. Risk factors were analyzed to determine their effect on the therapeutic results of PEDD. Clinical outcomes were assessed by careful physical examination, regular serologic testing, and imaging studies to determine whether continued conservative treatment or open surgery was necessary. Causative bacteria was identified in 17 (85%) of the 20 biopsy specimens. Successful infection control through PEDD was identified in 13 patients (65%). Both the visual analog scale and Oswestry disability index significantly improved in these patients. Detection of the causative pathogens was the only risk factor influencing the terminal event in the remaining seven patients (35%). In this study, PEDD was an effective treatment approach for obtaining a bacteriological diagnosis, relieving the patient's symptoms, and assisting in eradication of SSI following instrumented lumbar fusion. The use of species-specific antibiotics for the offending pathogens appears to be the most important factor to determine the success rate. The indications of this procedure could be extended to treat patients with SSI after instrumented lumbar fusion.

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

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