Percutaneous endoscopic discectomy and drainage for infectious spondylitis

Yang, Shih-Chieh; Fu, Tsai-Sheng; Chen, Lih-Huei; Niu, Chi‐Chien; Lai, Po‐Liang; Chen, Wen-Jer

doi:10.1007/s00264-006-0188-6

Cited by 56 publications

(45 citation statements)

References 24 publications

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“…The positive culture rate was comparable to that obtained with open biopsy and superior to that of the CT-guided biopsy group. The size of the biopsy needle or discectomy forceps determines the sample size, which correlates to the positivity of the culture rate [2,6,22]. A sufficient amount of specimen can be obtained through PEDD with the patient under local anesthesia, avoiding the potential morbidity associated with an extensive surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Identifying Pathogens of Spondylodiscitis: Percutaneous Endoscopy or CT-guided Biopsy

Yang

Chen

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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106

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Identifying offending pathogens is crucial for appropriate antibiotic administration for infectious spondylitis. Although computed tomography (CT)-guided biopsy for bacteriologic diagnosis is a standard procedure, it has a variable success rate. Some reports claim percutaneous endoscopic discectomy and drainage offer a sufficient amount of tissue for microbiologic examination and easy application. We therefore compared the diagnostic value of CT guidance with that of endoscope guidance in 52 patients with suspected infectious spondylitis. Twenty patients underwent percutaneous endoscopic discectomy and drainage by an orthopaedic surgeon and the other 32 patients underwent CT-guided biopsies by a radiologist. Patients were followed a minimum of 12 months after treatment. Culture results of the biopsy specimens were recorded. Causative bacteria were identified more frequently with percutaneous endoscopy than in CT-guided biopsy (18 of 20 [90%] versus 15 of 32 [47%]). We observed no biopsy-related complications or side effects in either group. The data suggest percutaneous endoscopic discectomy and drainage yield higher bacterial recovery rates than CT-guided spinal biopsy. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

“…Percutaneous endoscopic discectomy and drainage (PEDD), a relatively new technique, is emerging because of its simplicity and apparent diagnostic accuracy from 45% to 87% according to the organism isolated [10,13,22].…”

Section: Introductionmentioning

confidence: 99%

Identifying Pathogens of Spondylodiscitis: Percutaneous Endoscopy or CT-guided Biopsy

Yang

Chen

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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106

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“…Delay in appropriate treatment for spinal infections can further lead to structural instability, spinal deformity, sepsis, neurologic deficit, and even death. The efficacy of PELD in terms of its diagnostic and therapeutic value has already been reported in several studies [13][14][15]. Most of these studies emphasized the importance of earlystage infection control, which usually leads to satisfactory outcomes.…”

Section: Discussionmentioning

confidence: 96%

“…However, the continuous irrigation restrained the patients to their beds and limited their postoperative ambulation and activities. The diagnostic and therapeutic value of percutaneous endoscopic lavage and drainage (PELD) has already been proved in some recent studies [13][14][15]. However, most of these studies focused on the effect of PELD in early-stage infection.…”

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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“…In 2007, Ito et al [17] and Yang et al [18] reported the results of percutaneous endoscopic discectomy and drainage (PEED) applied to 15 cases (30 cases in total). Ito et al conducted a detailed evaluation of pain alleviation using a visual analog scale (VAS, 0-100mm).…”

Section: Discussionmentioning

confidence: 99%

Surgical Results of Percutaneous Suction Aspiration and Drainage for Pyogenic Spondylitis

et al. 2010

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Summary:Forty patients (24 male and 16 female; age 13-87 years, mean 66 years) with pyogenic spondylitis were treated by percutaneous suction aspiration and drainage between January 1997 and September 2007 at Kurume University Hospital. The surgical procedure and transpedicular approach were similar to those used for percutaneous discectomy in the treatment of intervertebral disc herniation. The average postoperative follow-up period was 22.6 months. Two patients had died by the time of the survey, and two had undergone multiple operations. The clinical outcomes were excellent in 12 patients, good in 17 patients, fair in 5 patients, and poor in 6 patients. The response rate (cases with "excellent" or "good" outcomes) was 72.5% (29 patients). Identification of the organism was possible in 26 patients (65%). The most frequently identified organism was methicillinresistant Staphylococcus aureus (MRSA; 11 cases), followed by methicillin-sensitive Staphylococcus aureus (MSSA; 5 cases) and Escherichia coli (3 cases). Percutaneous suction aspiration and drainage has been demonstrated as an effective means of treating early spondylitis. This procedure is minimally invasive and enables pathogen identification, histopathological diagnosis and even simultaneous treatment. This is the only means of treatment available for patients who cannot tolerate open surgery. This therapy also promises medico-economic advantages by shortening treatment periods and eliminating open surgery.

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Percutaneous endoscopic discectomy and drainage for infectious spondylitis

Cited by 56 publications

References 24 publications

Identifying Pathogens of Spondylodiscitis: Percutaneous Endoscopy or CT-guided Biopsy

Identifying Pathogens of Spondylodiscitis: Percutaneous Endoscopy or CT-guided Biopsy

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

Surgical Results of Percutaneous Suction Aspiration and Drainage for Pyogenic Spondylitis

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