Continuous Irrigation in Pyogenic Spondylitis Accompanied by Iliopsoas Abscess

Tofuku, Katsuhiro; Koga, Hiroaki; Yone, Kazunori; Komiya, Setsuro

doi:10.1097/brs.0b013e318067e35e

Cited by 17 publications

(12 citation statements)

References 16 publications

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“…Percutaneous suction, aspiration, drainage and continuous irrigation with local administration of antibiotic agents have also been found to be effective in patients with early-stage pyogenic spondylitis (5,17). Such techniques have also been used for the treatment of pyogenic spondylitis accompanied by iliopsoas abscess (6,7). However, the continuous irrigation restrained the patients to their beds and limited their postoperative ambulation and activities.…”

Section: Discussionmentioning

confidence: 97%

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Percutaneous endoscopic debridement and drainage in immunocompromised patients with complicated infectious spondylitis

Yang

Tsai

et al. 2010

Minimally Invasive Therapy & Allied Technologies

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Percutaneous endoscopic debridement and drainage (PEDD) has been reported to be an effective procedure in treating early infectious spondylodiscitis. However, it is not clear whether PEDD can be effective in treating cases of complicated infectious spondylitis with significant abscess formation or vertebral destruction. Two women and four men with poor general health and complicated pyogenic spondylitis who underwent PEDD were evaluated. The causative bacteria were identified by PEDD in five of six. All six patients presented with spinal pain. Five patients reported relief from back pain within one week of surgery and recovered uneventfully after full course, specific, antimicrobial therapy. C-reactive protein (CRP) values returned to normal ranges within two to 22 weeks in these patients. The follow-up magnetic resonance imaging studies revealed that the paraspinal abscesses or epidural abscesses were resolved. No surgery-related complications were noted during or after the PEDD procedure. In conclusion, PEDD was effective in treating complicated infectious spondylitis. We propose that PEDD is an effective alternative to extensive surgery for complicated infectious spondylitis, especially in patients with multiple comorbidities.

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Section: Discussionmentioning

confidence: 97%

“…A few reports have also described the use of such techniques in treating pyogenic spondylitis accompanied by iliopsoas abscess or marked bone destruction (6,7). However, continuous irrigation restrains the patients to their beds and limits postoperative ambulation and activities.…”

Section: Introductionmentioning

confidence: 97%

Percutaneous endoscopic debridement and drainage in immunocompromised patients with complicated infectious spondylitis

Yang

Tsai

et al. 2010

Minimally Invasive Therapy & Allied Technologies

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“…[36,37] However, this technique lacks endoscopic monitoring for debridement of the lesion site. Furthermore, the continuous irrigation confines the patients to their beds and limits postoperative ambulation and activities.…”

Section: Efficacy Of Pedd For Complicated Infectious Spondylodiscitismentioning

confidence: 99%

“…[27,28] Similarly, several minimally invasive spinal techniques had been developed and used to treat infectious spondylodiscitis. [29][30][31][32][33][34][35][36][37] CT-guided percutaneous catheter drainage, [19] percutaneous transpedicular discectomy and drainage, [29,32] percutaneous drainage and continuous irrigation, [33,36] percutaneous suction aspiration and drainage, [34,37] and automated percutaneous flexible nucleotome debridement [30,35] through a unilateral or bilateral posterolateral approach have been reported as efficient and safe procedures in the management of early-stage spondylodiscitis. However, these procedures lack intraoperative virtual images monitoring for debridement of the lesion site.…”

Section: Minimally Invasive Spinal Surgery For Spondylodiscitismentioning

confidence: 99%

Minimally invasive percutaneous endoscopic discectomy and drainage for infectious spondylodiscitis

Fu¹,

Chen²,

Chen³

2013

Biomed J

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The primary goals for treating infectious spondylodiscitis are to make an accurate diagnosis, isolate the causative organism, and prescribe effective antibiotic therapy based on the culture data. A positive culture of the responsible organism is not required for diagnosis, although it is extremely important for successful treatment and prevention of further morbidity. Surgical intervention is usually reserved for cases that are unresponsive to antibiotic therapy and for patients who have developed progressive spinal deformity or instability, epidural abscesses, or neurological impairment. However, the incidence of perioperative morbidity is particularly increased in elderly patients or in those with poor general condition. With improved endoscopic instruments and techniques, our clinical experiences demonstrate that spinal infections can be successfully treated by minimally invasive percutaneous endoscopic debridement. Direct endoscopic observation and collection of sufficient quantities of samples for microbiological examinations from the infected region are usually possible. This article summarizes the diagnostic and therapeutic values of percutaneous endoscopic discectomy and drainage (PEDD) used to treat patients with spondylodiscitis. Our clinical evidence-based survey suggests that PEDD can provide adequate retrieval of specimens and has high diagnostic efficacy, thereby enabling prompt and sensitive antibiotic therapy to the offending pathogens. We propose that PEDD is an effective alternative for treating infectious spondylodiscitis and should be considered prior to extensive anterior surgery in selected cases. This method is particularly suitable for patients with early-stage spinal infection or serious medical conditions. (Biomed J 2013;36:168-174)

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“…They concluded that it is a useful and minimally invasive technique for the conservative treatment of lumbar discitis, although the causative pathogens could be identified in only 45 % of their cases. Percutaneous suction, aspiration, drainage, and continuous irrigation with local administration of antibiotics have also been found to be effective in patients with an early-stage pyogenic spondylitis and even spinal infection accompanied by iliopsoas abscesses [9][10][11][12]. However, the continuous irrigation restrained the patients to their beds and limited their postoperative ambulation and activities.…”

Section: Introductionmentioning

confidence: 99%

Extended indications of percutaneous endoscopic lavage and drainage for the treatment of lumbar infectious spondylitis

Yang

Chen

et al. 2014

Eur Spine J

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Purpose The treatment of spinal infection remains a challenge for spinal surgeons because of the variable presentations and complicated course. The diagnostic and therapeutic value of percutaneous endoscopic lavage and drainage (PELD) has been proved in some recent studies. The purpose of this study is to evaluate the efficacy of PELD in patients with advanced infectious spondylitis which may traditionally require open surgery. Methods We retrospectively reviewed the medical records of 21 patients who underwent PELD to treat their advanced lumbar infectious spondylitis. Patients with severe infection resulting in significant neurological deficit and mechanical instability were excluded from the PELD procedure, which was only used on selected patients with less severe disease. The 21 patients were categorized into three groups based on their past history, clinical presentation, and imaging studies: those with paraspinal abscesses, postoperative recurrent infection, and multilevel infection. Clinical outcomes were assessed by careful physical examination, Odom's criteria, regular serologic testing, and imaging studies to determine whether continued conservative treatment or surgical intervention was necessary. Results Causative bacteria were identified in 19 (90.5 %) of 21 biopsy specimens. Appropriate parenteral antibiotics for the predominant pathogen isolated from the infected tissue biopsy cultures were prescribed for the patients. All patients reported satisfactory recovery and relief of back pain, except three with multilevel infections who underwent anterior debridement and fusion within 2 weeks after treatment with PELD. The overall infection control rate was 86 %. One patient with epidural abscess and spondylolytic spondylolisthesis of the L5-S1 received instrumented fusion surgery due to mechanical instability 5 months later. No surgery-related major complications were found, except 2 patients who had transient paraesthesia in the affected lumbar segment. Conclusions PELD was successful in obtaining a bacteriologic diagnosis, relieving the patient's symptoms, and assisting in eradication of lumbar infectious spondylitis. The indications of this minimally invasive procedure could be extended to treat patients suffering from spinal infections with paraspinal abscesses and postoperative recurrent infection. Patients with multilevel infection may have trivial benefits from PELD due to poor infection control and mechanical instability of the affected segments.

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Continuous Irrigation in Pyogenic Spondylitis Accompanied by Iliopsoas Abscess

Abstract: This treatment is minimally invasive and useful in carefully selected patients with pyogenic spondylitis complicated by iliopsoas abscess.

Cited by 17 publications

References 16 publications

Percutaneous endoscopic debridement and drainage in immunocompromised patients with complicated infectious spondylitis

Percutaneous endoscopic debridement and drainage in immunocompromised patients with complicated infectious spondylitis

Minimally invasive percutaneous endoscopic discectomy and drainage for infectious spondylodiscitis

Extended indications of percutaneous endoscopic lavage and drainage for the treatment of lumbar infectious spondylitis

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