New Strategy for Minimally Invasive Endoscopic Surgery to Treat Infectious Spondylodiscitis in the Thoracolumbar Spine

摘要

Background: Eradicating infection, protecting neurologic function, and maintaining structuralalignment are the 3 objectives of treatment for infectious spondylodiscitis. For some patients,surgery may be necessary to achieve these goals; however, open surgeries are associatedwith high morbidity and mortality in elderly patients and those with multiple comorbidities.Endoscopic surgery provides a minimally invasive surgical option for obtaining a culture sampleto aid identification of pathogens, while also providing a route for adequate decompressionand drainage. The clinical results of this study were analyzed.Objectives: To evaluate the efficacy and safety of spinal endoscopic surgery, the basiccharacteristics of patients analyzed and their inflammatory markers, pain levels, and localkyphotic angles were recorded before surgery and at regular intervals after surgery. The patients’cultured pathogens and previous antibiotic treatments were also recorded and analyzed.Study Design: Retrospective observational study (institutional review board: CMUH105-REC2-101).Setting: Inpatient surgery center.Methods: From October 2006 to March 2017, of 508 patients who received spinal endoscopicsurgery, 60 with infectious spondylodiscitis were treated using this new strategy. All 60 patientsunderwent plain film radiography and enhanced magnetic resonance imaging of the affectedregion to obtain evidence of infectious spondylodiscitis. The role of a computed tomographyguided biopsy and some indications for open surgery were replaced with endoscopic surgery.Results: All the patients reported rapid pain relief after endoscopic surgery and antibiotictreatment. No significant changes in sagittal alignment were observed in final follow-upradiography images. Causative pathogens were identified in 34 patients (culture rate: 77.27%)without previous antibiotic treatment. The patients’ erythrocyte sedimentation rates andC-reactive protein levels had decreased significantly 3 months after endoscopic surgery. Twopatients (3.3%) experienced infection relapse following initial endoscopic surgery; both ofthem were efficiently resolved through a second round of endoscopic surgery. No surgeryrelated complications were observed and no open spinal surgery was required during thefollow-up period.Limitations: This was a retrospective study; bias was unavoidable because of the singlecenter nature of the study design.Conclusions: Regarding the culture rate, recurrence rate, kyphotic change, and surgeryrelated complications, this new strategy for endoscopic surgery is safe and effective for treatinginfectious spondylodiscitis in the thoracic or lumbar spine and may be considered a new trendin treating diseases of this type.