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

Abstract

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.

The Need for Comprehensive Medical Management in Pyogenic Spondylodiscitis: A Review Article

“…Comprehensive Medical Management in Pyogenic Spondylodiscitis 16 postoperative complications in his series, which were most commonly instrumentation failure and wound dehiscence 55 . Wang et al saw that open surgery entails high blood loss, leads to frequent blood transfusion, and has a 10% mortality rate 56 . Also, surgically treated patients are predisposed to high odds of having medical complications (odds ratio [OR]: 2.62) and surgical site infection (odds ratio [OR]: 6.04) leading to prolonged hospital stay 57 .…”

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

“…Surgical approaches for PSD include PLIF [14], PELD [15], and minimally invasive surgery [16]. Recently, some scholars have proposed a surgical method that combines the advantages of minimally invasive debridement of infectious lesions and percutaneous posterior instrumented spinal fusion, known as percutaneous endoscopic interbody debridement and fusion (PEIDF) [17]. However, few patients have undergone this procedure, and the surgical efficacy requires further validation over a longer period of time [18].…”