1. 2019;22;281-293New Strategy for Minimally Invasive Endoscopic Surgery to Treat Infectious Spondylodiscitis in the Thoracolumbar Spine
   Observational Study
   Chia-Yu Lin, MD, Chien-Chun Chang, MD, Yen-Jen Chen, MD, Chun-Hao Tsai, MD, PhD, Hsi-Kai Tsou, MD, PhD, Chih-Sheng Lin, PhD, Mao-Wang Ho, MD, Hsien-Te Chen, MD, PhD, and Horng-Chaung Hsu, MD, PhD.

BACKGROUND: Eradicating infection, protecting neurologic function, and maintaining structural alignment are the 3 objectives of treatment for infectious spondylodiscitis. For some patients, surgery may be necessary to achieve these goals; however, open surgeries are associated with high morbidity and mortality in elderly patients and those with multiple comorbidities. Endoscopic surgery provides a minimally invasive surgical option for obtaining a culture sample to aid identification of pathogens, while also providing a route for adequate decompression and drainage. The clinical results of this study were analyzed.

OBJECTIVES: To evaluate the efficacy and safety of spinal endoscopic surgery, the basic characteristics of patients analyzed and their inflammatory markers, pain levels, and local kyphotic 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: CMUH 105-REC2-101).

SETTING: Inpatient surgery center.

METHODS: From October 2006 to March 2017, of 508 patients who received spinal endoscopic surgery, 60 with infectious spondylodiscitis were treated using this new strategy. All 60 patients underwent plain film radiography and enhanced magnetic resonance imaging of the affected region to obtain evidence of infectious spondylodiscitis. The role of a computed tomography-guided biopsy and some indications for open surgery were replaced with endoscopic surgery.

RESULTS: All the patients reported rapid pain relief after endoscopic surgery and antibiotic treatment. No significant changes in sagittal alignment were observed in final follow-up radiography images. Causative pathogens were identified in 34 patients (culture rate: 77.27%) without previous antibiotic treatment. The patients’ erythrocyte sedimentation rates and C-reactive protein levels had decreased significantly 3 months after endoscopic surgery. Two patients (3.3%) experienced infection relapse following initial endoscopic surgery; both of them were efficiently resolved through a second round of endoscopic surgery. No surgery-related complications were observed and no open spinal surgery was required during the follow-up period.

LIMITATIONS: This was a retrospective study; bias was unavoidable because of the single-center nature of the study design.

CONCLUSIONS: Regarding the culture rate, recurrence rate, kyphotic change, and surgery-related complications, this new strategy for endoscopic surgery is safe and effective for treating infectious spondylodiscitis in the thoracic or lumbar spine and may be considered a new trend in treating diseases of this type.

KEY WORDS: Spine, endoscopic, discectomy, spondylodiscitis, minimally invasive surgery