Minimally invasive debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis: a long‐term follow‐up study

Abstract

Background Spondylodiscitis is an unusual infectious disease, which usually originates as a pathogenic infection of intervertebral discs and then spreads to neighboring vertebral bodies. The objective of this study is to evaluate percutaneous debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis. Methods From January 2002 to May 2017, 23 patients with multilevel spondylodiscitis were treated with minimally invasive debridement and drainage procedures in our department. The clinical manifestations, evolution, and minimally invasive debridement and drainage treatment of this refractory vertebral infection were investigated. Results Of the enrolled patients, the operation time ranged from 30 minutes to 124 minutes every level with an average of 48 minutes. Intraoperative hemorrhage was minimal. The postoperative follow-up period ranged from 12 months to 6.5 years with an average of 3.7 years. There was no reactivation of infection in the treated vertebral segment during follow-up, but two patients with fungal spinal infection continued to progress by affecting adjacent segments prior to final resolution. According to the classification system of Macnab, one patient had a good outcome at the final follow-up, and the rest were excellent. Conclusions Minimally invasive percutaneous debridement and irrigation using intraoperative CT-Guide is an effective minimally invasive method for the treatment of multilevel spondylodiscitis.

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

“…11,12 CT-guided percutaneous biopsy, debridement and drainage are safe and effective in spondylodiscitis. 13 The diagnosis of lumbar infectious spondylitis is based on the patient’s symptoms, imaging examination, serologic testing, pathology, bacteriology and molecular biology. Preoperative blood cultures serve as a basis for diagnosis.…”

Outcome of One-Stage Percutaneous Endoscopic Debridement and Lavage Combined with Percutaneous Pedicle Screw Fixation for Lumbar Pyogenic Spondylodiscitis

“…Negative microbial cultures do not rule out infection if the patient has been treated with antibiotics before sampling [10].A positive intervertebral space tissue specimen culture is the gold standard for diagnosing pathogenic microorganisms. However, the positive rate of microbial culture after a needle biopsy varies greatly among researchers [11,12].CT-guided percutaneous biopsy, debridement, and drainage are safe and effective in spondylodiscitis [13].The diagnosis of lumbar infectious spondylitis is based on the patient's symptoms, imaging examination, serologic testing, pathology, bacteriology, and molecular biology. Preoperative blood cultures serve as a basis for diagnosis.…”

Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

“…За допомогою КТ можна виявити такі зміни, як раннє руйнування кінцевих пластинок, склероз тіл хребців, зниження висоти і щільності міжхребцевих дисків, латеродислокацію, анте-і ретролістез тіл хребців, наявність набряку паравертебральних тканин, формування гнійної деструкції тканин. Зміни в міжхребцевих дисках проявляються у вигляді гіподенсивних ділянок [9][10][11]. КТ дає найбільш чітке зображення секвестрів та патологічної кальцифікації.…”

“…CT can detect such changes as early destruction of endplates, sclerosis of vertebral bodies, decreased height, and density of inter-vertebral discs, laterodislocation, ante-and retrolisthesis of vertebral bodies, the presence of paravertebral tissue oedema, the formation of suppurative tissue destruction. Changes in the intervertebral discs are seen as hypotensive areas [9,11]. CT gives the clearest image of sequestration and pathological calcifi cation.…”