Minimally invasive endoscopic treatment for lumbar infectious spondylitis: a retrospective study in a tertiary referral center

BMC Musculoskeletal Disorders

Yuan-Kun Tu¹  Shang-Won Yu¹  Yu-Hsien Kao¹  Hung-Shu Chen¹  Tsai-Sheng Fu²  Shih-Chieh Yang¹ 

[1] Department of Orthopaedic Surgery and Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan;Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

关键词: Minimally invasive surgery;    Infectious spondylitis;    Endoscopic debridement;    Betadine;   

Others  :  1127808
DOI  :  10.1186/1471-2474-15-105

 received in 2013-07-16, accepted in 2014-03-25,  发布年份 2014

【 摘 要 】

Background

Spinal infections remain a challenge for clinicians because of their variable presentation and complicated course. Common management approaches include conservative administration of antibiotics or aggressive surgical debridement. The purpose of this study was to evaluate the efficacy of percutaneous endoscopic debridement with dilute betadine solution irrigation (PEDI) for treating patients with lumbar infectious spondylitis.

Methods

From January 2005 to July 2010, a total of 32 patients undergoing PEDI were retrospectively enrolled in this study. The surgical indications of the enrolled patients included single-level infectious spondylodiscitis, postoperative infectious spondylodiscitis, advanced infection with epidural abscess, psoas muscle abscess, pre-vertebral or para-vertebral abscess, multilevel infectious spondylitis, and recurrent infection after anterior debridement and fusion. Clinical outcomes were assessed by careful physical examination, Macnab criteria, regular serologic testing, and imaging studies to determine whether continued antibiotics treatment or surgical intervention was required.

Results

Causative bacteria were identified in 28 (87.5%) of 32 biopsy specimens. Appropriate parenteral antibiotics for the predominant pathogen isolated from infected tissue biopsy cultures were prescribed to patients. Twenty-seven (84.4%) patients reported satisfactory relief of their back pain after PEDI. Twenty-six (81.3%) patients recovered uneventfully after PEDI and sequential antibiotic therapy. No surgery-related major complications were found, except 3 patients with transient paresthesia in the affected lumbar segment.

Conclusions

PEDI was successful in obtaining a bacteriologic diagnosis, relieving the patient’s symptoms, and assisting in the eradication of lumbar infectious spondylitis. This procedure could be an effective alternative for patients who have a poor response to conservative treatment before a major open surgery.

【 授权许可】

   
2014 Yang et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]An HS, Seldomridge JA: Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res 2006, 444:27-33.
• [2]Bonfiglio M, Lange TA, Kim YM: The Classic: pyogenic vertebral osteomyelitis: disk space infections. Clin Orthop Relat Res 2006, 444:4-8.
• [3]Carragee EJ: Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 1997, 79:874-880.
• [4]Rezai AR, Woo HH, Errico TJ, Cooper PR: Contemporary management of spinal osteomyelitis. Neurosurgery 1999, 44:1018-1025.
• [5]Chew FS, Kline MJ: Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis. Radiology 2001, 218:211-214.
• [6]Rankine JJ, Barron DA, Robinson P, Millner PA, Dickson RA: Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J 2004, 80:607-609.
• [7]Yang SC, Fu TS, Chen LH, Chen WJ, Tu YK: Identify pathogen of spondylodiscitis: Percutaneous endoscopy or CT-guided biopsy. Clin Orthop Relat Res 2008, 466:3086-3092.
• [8]Kambin P, Schaffer JL: Percutaneous lumbar discectomy. Review of 100 patients and current practice. Clin Orthop Relat Res 1989, 238:24-34.
• [9]Hermantin FU, Peters T, Quartararo L, Kambin P: A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg Am 1999, 81:958-965.
• [10]Yeung AT, Tsou PM: Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002, 27:722-731.
• [11]Ito M, Abumi K, Kotani Y, Kadoya K, Minami A: Clinical outcome of posterolateral endoscopic surgery for pyogenic spondylodiscitis: results of 15 patients with serious comorbid conditions. Spine 2007, 32:200-206.
• [12]Yang SC, Fu TS, Chen LH, Niu CC, Lai PL, Chen WJ: Percutaneous endoscopic discectomy and drainage for infectious spondylitis. Int Orthop 2007, 31:367-373.
• [13]Fu TS, Yang SC, Tsai TT, Chen LH, Lai PL, Niu CC, Chen WJ: Percutaneous endoscopic debridement and drainage in immunocompromised patients with complicated infectious spondylitis. Minim Invasive Ther Allied Technol 2010, 19:42-47.
• [14]Hill RL, Casewell MW: The in-vitro activity of povidone-iodinecream against Staphylococcus aureus and its bioavailability in nasal secretions. J Hosp Infect 2000, 45:198-205.
• [15]McLure AR, Gordon J: In-vitro evaluation of povidone-iodine and chlorhexidine against methicillin-resistant Staphylococcus aureus. J Hosp Infect 1992, 21:291-299.
• [16]Reimer K, Wichelhaus TA, Schäfer V, Rudolph P, Kramer A, Wutzler P, Ganzer D, Fleischer W: Antimicrobial effectiveness of povidone-iodine and consequences for new application areas. Dermatology 2002, 204(Suppl 1):114-120.
• [17]Block C, Robenshtok E, Simhon A, Shapiro M: Evaluation of chlorhexidine and povidone iodine activity against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecalis using a surface test. J Hosp Infect 2000, 46:147-152.
• [18]Yasuda T, Yoshimura S, Katsuno Y, Takada H, Ito M, Takahashi M, Yahazaki F, Iriyama J, Ishigo S, Asano Y: Comparison of bactericidal activities of various disinfectants against methicillin-sensitive Staphylococcus aureus and methicillin-resistant Staphylococcus aureus. Postgrad Med J 1993, 69(Suppl 3):66-69.
• [19]Kaysinger KK, Nicholson NC, Ramp WK, Kellam JF: Toxic effects of wound irrigation solutions on cultured tibiae and osteoblasts. J Orthop Trauma 1995, 9:303-311.
• [20]Goldenheim PD: An appraisal of povidone-iodine and wound healing. Postgrad Med J 1993, 69(Suppl 3):97-105.
• [21]Macnab I: Negative disc exploration. An analysis of the cause of nerve root involvement in sixty-eight patients. J Bone Joint Surg Am 1971, 53:891-903.
• [22]Emery SE, Chan DP, Woodward HR: Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine 1989, 14:284-291.
• [23]Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ: Hematogenous pyogenic spinal infections and their surgical management. Spine 2000, 25:1668-1679.
• [24]Krodel A, Sturz H, Siebert CH: Indications for and results of operative treatment of spondylitis and spondylodiscitis. Arch Orthop Trauma Surg 1991, 110:78-82.
• [25]Ozuna RM, Delamarter RB: Pyogenic vertebral osteomyelitis and postsurgical disc space infections. Orthop Clin North Am 1996, 27:87-94.
• [26]Staatz G, Adam GB, Keulers P, Vorwerk D, Günther RW: Spondylodiskitic abscesses: CT-guided percutaneous catheter drainage. Radiology 1998, 208:363-367.
• [27]Haaker RG, Senkal M, Kielich T, Krämer J: Percutaneous lumbar discectomy in the treatment of lumbar discitis. Eur Spine J 1997, 6:98-101.
• [28]Nagata K, Ohashi T, Ariyoshi M, Sonoda K, Imoto H, Inoue A: Percutaneous suction aspiration and drainage for pyogenic spondylitis. Spine 1998, 15:1600-1606.
• [29]Hadjipavlou AG, Katonis PK, Gaitanis IN, Muffoletto AJ, Tzermiadianos MN, Crow W: Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis. Eur Spine J 2004, 13:707-713.
• [30]Hanaoka N, Kawasaki Y, Sakai T, Nakamura T, Nanamori K, Nakamura E, Uchida K, Yamada H: Percutaneous drainage and continuous irrigation in patients with severe pyogenic spondylitis, abscess formation, and marked bone destruction. J Neurosurg Spine 2006, 4:374-379.
• [31]Tofuku K, Koga H, Yone K, Komiya S: Continuous irrigation in pyogenic spondylitis accompanied by iliopsoas abscess. Spine 2007, 32:E382-E387.
• [32]Cheng MT, Chang MC, Wang ST, Yu WK, Liu CL, Chen TH: Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery. Spine 2005, 30:1689-1693.