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

Abstract

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.

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

“…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.…”

“…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.…”

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases

“…Nevertheless, open pedicle screw fixation with TLIF is an invasive surgical intervention that may be associated with several risks [8]. Therefore, minimally invasive techniques have been developed for degenerative diseases and have been applied in infected cases to minimize tissue damage, reduce narcotic requirements, decrease blood loss, and, therefore, potentially avoid prolonged immobilization [9][10][11][12]. This is of great interest especially in spondylodiscitis patients who frequently suffer from severe comorbidities.…”

Evaluation and Management of Pyogenic and Tubercular Spine Infections

“…While an anterior approach allows direct exposure for debridement and reconstruction, the posterior approach allows for posterior instrumentation, debridement, and reconstruction with one approach but may limit direct access to pathology. As surgeons become more proficient with minimally invasive surgery (MIS) techniques, MIS posterior and direct lateral retroperitoneal approaches have been published for PSI with successful results [26][27][28]. The surgical approach for cervical discitis between anterior debridement and fusion or circumferential approaches is controversial.…”