Intra-discal drain insertion for culture and drainage of pyogenic spondylodiscitis: A one-step diagnostic and therapeutic procedure

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Pyogenic spondylodiscitis is diagnosed in recent years at higher rates due to the aging population, increased survival of chronic and immune suppressed patients, and the higher rate of invasive procedures leading to bacterial seeding or direct contamination of the disc space. Treatment guidelines encourage bacterial sampling before initiation of antibiotic therapy, and drainage of pus collections. We present our experience with percutaneous CT-guided drain insertion into the disc space itself as a one-step procedure for both culturing and subsequent continuous drainage of the infected disc space. </jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p> We retrospectively reviewed all cases of pyogenic spondylodiscitis admitted to our spine surgery unit during the past five years and treated with CT-guided percutaneous drain insertion into the infected disc space. All patients were followed until complete resolution of the infection. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> We retrieved electronic records of 12 patients, none presenting with neurological compression symptoms. Cultures taken at the time of drain insertion were positive in 10 patients (83.3%), much higher than the reported yield for needle aspiration (14–48%) and comparable to the yield of open biopsy. In all patients complete resolution of the infection was reached, determined by clinical, laboratory, and imaging parameters. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Our retrospective case series demonstrates the feasibility and effectiveness of intra-discal CT-guided drainage of an infected disc space. The procedure does not add much burden to current practice as disc-space sampling for culture is commonly performed anyway, and adds the benefit of direct drainage of the pus at its source. </jats:p></jats:sec>

Usefulness of Percutaneous Drainage in Determining the Causative Microorganism in Patients with Spondylodiscitis: A Retrospective Cross-Sectional Study

“…CT-guided percutaneous drainage (CTPD) is a technique that involves tube insertion into the vertebral disc space as well as specimen sampling and continuous drainage from the infected site simultaneously [9]. The rate of microorganism detection via insertion of the drainage tube into the infected vertebral disc space was reported to be 76.2%-83.3% [9,10]. We hypothesized that CTPD could reveal the causative microorganism in patients who received antibiotics before blood culture as the vertebral disc is less vascularized and the immune reaction or antibiotics are not effective [5].…”