Minimally invasive percutaneous endoscopic discectomy and drainage for infectious spondylodiscitis

Abstract

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)

Die bakterielle unspezifische “pyogene” Spondylodiszitis

“…Durch die geringere operative Morbidität, die Verminderung des Weichteiltraumas besonders bei adipösen Patienten und die in der Regel verkürzte OP-Zeit bei multimorbiden Patienten haben sich diese Verfahren bei geeigneten Patienten bewährt. Die alleinige perkutane Diskektomie und Drainage wird angegeben (33). Reine Instrumentationen im Sinne einer internen Stabilisierung, aber auch zusätzliche Dekompressionen und perkutane Abszessentlastungen sind möglich (2,13,25).…”

Die schweregradorientierte Therapie der Spondylodiszitis – eine prospektive Betrachtung anhand von elektronisch basierten Behandlungspfaden

“…Bei einem konservativen Therapieansatz stehen neben der Ruhigstellung und gezielten antibiotischen Therapie auch minimalinvasive Verfahren zur Verfügung. So werden perkutane CT-gestützte und endoskopische Bandscheibenentfernungen beschrieben, wie auch minimalinvasive transpedikuläre Kürettagen und Stabilisierungen [21,45,46].…”

“…Das therapeutische Ziel kann in leichteren Fällen, bei chronischen Verläufen oder inoperablen Patienten konservativ mit konsequenter Immobilisation, Korsett und resistenzgerechter Antibiotikagabe erreicht werden. Weitere Möglichkeiten einer minimalinvasiven Therapie sind die alleinige Abszessdrainage, die endoskopische Diskektomie oder transpedikuläre Biopsie und Drainage [21,22]. Die resistogrammgerechte Antibiose sollte zunächst parenteral appliziert werden und bei deutlichem Abfall der Entzündungswerte mit einer oralen Therapie fortgeführt werden.…”

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

“…Computed tomography- (CT-) guided biopsy and drainage are the standard procedure for identifying causative pathogens. However, the pathogen-identification rate varies among studies [ 2 – 4 ]. Surgical intervention is indicated if neurological deficit, progressive deformity, failure to respond to conservative treatment, or the need to obtain specimens to identify causative pathogens is present.…”

“…However, traditional anterior debridement and reconstruction with or without posterior instrumentation are associated with high rates of morbidity and mortality, especially in elderly immunocompromised patients and patients with multiple comorbidities. Percutaneous endoscopic discectomy, debridement, and drainage provide a minimally invasive surgical choice for the treatment of infectious spondylodiscitis [ 4 – 6 ]. This method provides adequate debridement and fast pain relief and has a relatively high pathogen-identification rate [ 4 , 7 , 8 ].…”