A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients

Chen, Hsin‐Chuan; Huang, Tzung-Chi; Chen, Yen-Jen; Tsou, Hsi‐Kai; Lin, Wei-Che; Hung, Chih‐Hung; Tsai, Chun‐Hao; Hsu, Horng‐Chaung; Chen, Hsien‐Te

doi:10.1155/2015/780451

Cited by 16 publications

(10 citation statements)

References 11 publications

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“…In Table 4, we compare our data with recently published studies on spontaneous spondylodiscitis. 3,7,9,18,22,23,[30][31][32][33][34]36 Compared to other series, our study had a mean patient age that was younger by more than 10 years, 27% of our patients were managed conservatively, only 8.3% of the conservatively managed patients required surgery, and 30-day overall mortality was less than 5%. Our series is similar to the other series in its male predominance.…”

Section: Discussionmentioning

confidence: 61%

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Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients

Waheed

Soliman

Ali

et al. 2019

Neurosurgical Focus

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OBJECTIVESpontaneous spondylodiscitis remains uncommon but is a serious complication of the vertebral column. Risk factors include diabetes, hemodialysis, intravenous drug abuse, and chronic steroid use, and pain is the most common presenting symptom. This study aims to review the literature and report on the incidence, management, and clinical outcome of spontaneous spondylodiscitis in 44 patients.METHODSThis is a prospective study including 44 patients with spontaneous spondylodiscitis managed in the neurosurgery department of Cairo University Hospitals during the period between January 2012 and October 2017. All patients had a full clinical assessment, laboratory tests, radiological studies in the form of MRI with and without contrast, and a postoperative follow-up of up to 12 months.RESULTSTwelve cases underwent conservative treatment in the form of complete bed rest, intravenous antibiotics, and a spinal brace. Ten cases underwent surgical intervention in the form of laminectomy, debridement, and open biopsy. Twenty-two cases underwent laminectomy and surgical stabilization with fusion. There were 15 cases of tuberculous spondylodiscitis, 6 cases of brucellosis, 6 cases of pyogenic infection, and 17 cases in which no organism could be detected.CONCLUSIONSOnce the primary diagnosis is confirmed, early and adequately prolonged antibiotic therapy is recommended for spontaneous spondylodiscitis. Some cases can be successfully treated with conservative treatment alone, whereas surgery may be needed in other cases such as severe destruction of endplates, spinal abscess formation, mechanical instability, neurological deficits, and severe pain that have failed to respond to conservative treatment.

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Section: Discussionmentioning

confidence: 61%

“…33 In our series, 2 patients required fusion surgery after laminectomy because of uncontrollable pain. Although open surgery has been the technique of choice traditionally, new publications refer to endoscopic 7 and minimally invasive 34 techniques for spondylodiscitis management.…”

Section: Antibiotic Treatment Decompression and Instrumented Fusionmentioning

confidence: 99%

Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients

Waheed

Soliman

Ali

et al. 2019

Neurosurgical Focus

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“…If significant publication bias was found, the Duval and Tweedie trim and fill method was used to adjust for the possible bias. bridement and drainage (PEDD), which is coupled with less complications and satisfactory clinical outcome, provides a minimally invasive surgical choice for the treatment of spinal infection (7)(8)(9)(10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

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

Cui

2019

Pain Phys

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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

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“…Chen et al . [ 4 ] reported quick pain relief from a VAS of 9.2–2.3 after MIS endoscopic surgery and antibiotic treatment for spondylodiscitis in a cohort of immunocompromised patients. Similarly, another group too reported that all patients showed immediate back pain reduction after surgery for discitis.…”

Section: Discussionmentioning

confidence: 99%

“…The benefits of MIS are all highly desirable features when treating patients with a suspected infection, especially since these patients are often sick or immunocompromised with multiple comorbidities. [ 4 5 6 7 ] This paper reports a series of patients with spinal infection in whom MIS techniques were employed to obtain a quick diagnosis to enable appropriate antibiotic therapy and faster recovery from pain, reduce the disease burden, and avoid a potentially bigger operation.…”

Section: Introductionmentioning

confidence: 99%

The role of minimally invasive spine surgery in the management of pyogenic spinal discitis

Turel

Kerolus

Deutsch

2017

J Craniovert Jun Spine

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Background:Diagnostic yields for spondylodiscitis from CT guided biopsy is low. In the recent years, minimally invasive surgery (MIS) has shown to have a low morbidity and faster recovery. For spinal infections, MIS surgery may offer an opportunity for early pain control while obtaining a higher diagnostic yield than CT-guided biopsies. The aim of this study was to review our patients who underwent MIS surgery for spinal infection and report outcomes.Methods:A retrospective review of seven patients who underwent MIS decompression and/or discectomy in the setting of discitis, osteomyelitis, spondylodiscitis, and/or an epidural abscess was identified. Patient data including symptoms, visual analog score (VAS), surgical approach, antibiotic regimen, and postoperative outcomes were obtained.Results:Of the 7 patients, 5 patients had lumbar infections and two had thoracic infections. All seven patients improved in VAS immediately after surgery and at discharge. The average VAS improved by 4.4 ± 1.9 points. An organism was obtained in 6 of the 7 (85%) patients by the operative cultures. All patients made an excellent clinical recovery without the need for further spine surgery. All patients who received postoperative imaging on follow-up showed complete resolution or dramatically improved magnetic resonance imaging changes. The follow-up ranged from 2 to 9 months.Conclusions:MIS surgery provides an opportunity for early pain relief in patients with discitis, osteomyelitis, spondylodiscitis, and/or epidural abscess by directly addressing the primary cause of pain. MIS surgery for discitis provides a higher diagnostic yield to direct antibiotic treatment. MIS surgery results in good long-term recovery.

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A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients

Cited by 16 publications

References 11 publications

Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients

Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients

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

The role of minimally invasive spine surgery in the management of pyogenic spinal discitis

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