Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis

Abstract

Background: Percutaneous endoscopic discectomy (PED) has been reported to be an effective procedure and minimally invasive surgical therapy for various spinal pathologies. Objective: To evaluate the clinical outcome of patients with pyogenic spondylitis who were treated with PED. Methods: Twenty-four patients with pyogenic spondylitis who underwent PED were evaluated for medical history, level of the affected intervertebral space, mode of onset, plain radiographs, epidural or psoas abscesses on MRI, results of blood and intraoperative sample cultures, preoperative C-reactive protein (CRP) level, time until postoperative CRP normalization (CRP < 0.3), and any additional surgery. Patients who underwent additional surgery and showed uncontrollable inflammation were considered to have “failed” PED for pyogenic spondylitis. To elucidate the factors that were significantly associated with a failure of PED for pyogenic spondylitis, statistical analyses were conducted by univariate analysis. Results: Control of inflammation was achieved in 19 of 24 patients (76%) after PED for pyogenic spondylitis. The remaining five patients failed to achieve infection control by PED. One such patient was not able to control the infection after PED, and another patient developed an epidural abscess 2 weeks after PED. Remaining three “failed” patients had exacerbations of their infections during the postoperative course and required additional surgery. Univariate analyses demonstrated that diabetes mellitus (DM; p = 0.05), hemodialysis due to DM-induced renal failure ( p = 0.02), concomitant malignant disease ( p = 0.09), and acute onset ( p = 0.05) were possibly correlated with PED failure. Stepwise logistic regression analysis revealed that hemodialysis due to DM-induced renal failure was an independent factor associated with PED failure ( p = 0.03). Conclusions: PED might be considered as one of the alternative therapeutic options before invasive radical surgeries for pyogenic spondylitis after failure of standard conservative therapy. Even by less invasive PED, pyogenic spondylitis patients with DM-hemodialysis showed poor outcome.

The Italian Landscape of Spine Endoscopy: Are We Ready for the Challenges of the Future?

“…The transforaminal route and its applications in treating intra-/extraforaminal disc herniation and stenosis are sometimes disregarded, possibly because the interlaminar route resembles more of a mini-invasive tubular approach. Meanwhile, worldwide, indications for FESS are moving from mild degenerative spine conditions to nervesheath tumour removal and infection debridement [22,37,38]. From our perception, by analyzing the age of the respondents, it seems that experienced surgeons, except for a few ones (i.e., less than a third who are experts in the endoscopic field, 8.8% of responders), seem reluctant to shift to endoscopic surgery and, in this way, limiting access to younger colleagues and residents.…”

Secondary Infection/Microbial Substitution in a Managed Case of Pyogenic Spondylitis

“…First of all, there is still no consensus on the optimal surgical strategy for PS [2]. Recently, the effectiveness of PPS fusion without anterior debridement is reported [11,12,18,19]; the effectiveness of intradiscal drainage with PEDD has been previously reported [2,4,5,[7][8][9][10]14,15,20]. There is a recent article reported successful case series treated by one-stage posterior fixation with anterior debridement from posterior approach [21].…”

“…Percutaneous drainage is a minimally invasive option [3]. Percutaneous endoscopic discectomy drainage (PEDD) is useful because it is minimally invasive and enables curettage of the infected area under visualization and simple puncture and drainage tube insertion [4][5][6][7][8][9][10]. Posterior percutaneous pedicle screw (PPS) fixation is a minimally invasive technique useful for infectious spinal conditions [11][12][13].…”