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Kang J, Xia X, Shang R, Wang X, Cao P, Wang J, Zhang J, Feng W, Wei J, Hu Q. Bilateral Endoscopic Debridement Combined with Local Antituberculosis Drugs for Thoracic Tuberculosis with Large Paravertebral Abscess: A Multicenter Study with 4-year Follow-Up. World Neurosurg 2024; 185:e1160-e1168. [PMID: 38499243 DOI: 10.1016/j.wneu.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Paravertebral abscess represents a prevalent manifestation of thoracic tuberculosis, often necessitating surgical intervention. In this study, we introduced a novel approach by employing bilateral endoscopic debridement (BED) to address large Paravertebral abscesses associated with thoracic tuberculosis, a method not previously proposed in the literature. The clinical efficacy was examined through a comprehensive 4-year follow-up. METHODS We conducted a retrospective analysis on patients diagnosed with thoracic tuberculosis and paravertebral abscess who underwent BED combined with local antituberculosis drugs (BED + LAD) between February 2015 and February 2019. A total of 29 eligible patients (12 males and 17 females) with a median (interquartile ranges) of 59.0(16.5) years were included in the study. All patients received the BED + LAD treatment. After the surgery, the patients were treated with a 4-drug antituberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol). All relevant indicators were meticulously recorded and analyzed. RESULTS The surgical procedures were successfully completed for all subjects, with an average intraoperative bleeding volume of (25.2 ± 8.9) ml, an average surgical time of (68.4 ± 14.0) minutes, an average fluoroscopy frequency of (21.7 ± 8.2) times, an average hospital stay of (14.2 ± 4.3) days, and an average medication period of (42.1 ± 9.6) weeks. All subjects completed at least a 4-year follow-up period. At the final follow-up, ESR and CRP levels returned to normal, and there was no significant increase in the Cobb angle (P>0.05). CONCLUSIONS The application of BED + LAD in the treatment of thoracic tuberculosis and paravertebral abscess proved to be a safe, effective, and feasible approach.
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Affiliation(s)
- Jian Kang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Xiujia Xia
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Rong'an Shang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Xiaoming Wang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Panju Cao
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Junfeng Wang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Jie Zhang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Wanli Feng
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Jianmin Wei
- Minimally Invasive Spine Department, Xi'an International Medical Center Hospital, Xi'an, Shaanxi, China
| | - Qiaolong Hu
- First Department of Orthopedics, Yulin Second Hospital, Yu Lin, Shaanxi, China.
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Scheyerer MJ, Herren C, Kühne C, Neufang J, Pieroh P, von der Höh NH. Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:621-628. [PMID: 34461670 DOI: 10.1055/a-1527-7939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite advances, the morbidity and mortality rates of patients with spondylodiscitis remains high, with an increasing incidence worldwide. Although conservative therapy has progressed, several cases require surgical intervention. However, the indication and opportunities for surgical treatment are still disputable. METHODS In a joint consensus, the members of the 'Spondylodiscitis' working group of the Spine Section of the German Society for Orthopaedics and Trauma Surgery considered current literature, particularly the newly published S2k guideline of the AWMF, and examined the surgical indications and treatment strategies for thoracolumbar spondylodiscitis. RESULTS Surgical intervention for spondylodiscitis is only required in a small percentage of patients. In studies comparing conservative and surgical therapies, most patients benefitted from surgery, regardless of the surgical technique selected. Presently, the standard procedure is a combined dorsoventral approach, in which a monolateral attempt should always be made. The choice of material (PEEK, titanium) for ventral support does not influence the clinical result.
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Affiliation(s)
- Max J Scheyerer
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Christian Herren
- Clinic for Trauma and Reconstructive Surgery, University Hospital Aachen, Germany
| | - Christian Kühne
- Trauma and Hand Surgery, Schön Clinic Hamburg-Eilbek, Germany
| | - Jörg Neufang
- Spinal Surgery, Professional Accidents Clinic Murnau, Germany
| | - Philipp Pieroh
- Clinic and Polyclinic for Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Germany
| | - Nicolas H von der Höh
- Clinic and Polyclinic for Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Germany
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Chen J, Xuan T, Lu Y, Lin X, Lv Z, Chen M. Outcome of one-stage percutaneous endoscopic debridement and lavage combined with percutaneous pedicle screw fixation for lumbar pyogenic spondylodiscitis. J Orthop Surg (Hong Kong) 2022; 29:23094990211065579. [PMID: 34911406 DOI: 10.1177/23094990211065579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study assessed the therapeutic effect of one-stage percutaneous endoscopic debridement and lavage (PEDL) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis. METHODS From March 2017 to October 2019, 51 patients diagnosed with pyogenic spondylodiscitis underwent PPSF followed by PEDL in our department. Biopsy specimens were examined for microorganisms and evaluated histopathologically. Clinical outcomes were assessed by physical examination, routine serological testing, visual analogue scale (VAS), Oswestry Disability Index (ODI) and imaging studies. RESULTS Of the enrolled patients, the operation time ranged from 90 min to 114 min every level with an average of 102 min, and the average drainage time ranged from 6 days to 10 days with an average of 7.4 days. All patients who complained of lower back pain symptoms were more relieved than before surgery. Causative pathogens were identified in 20 of 51 biopsy specimens; Staphylococcus aureus was the most prevalent. However, there were eight patients with postoperative complications. The mean follow-up was 25.0 ± 3.8 (range: 20-32) months. Inflammatory markers showed that infection was controlled. The VAS and ODI improved significantly. At the last follow-up, magnetic resonance imaging showed that the infected lesions had disappeared. CONCLUSION PEDL supplementing PPSF may be useful for patients with single-level lumbar pyogenic spondylodiscitis, as it is minimally invasive, especially for patients who cannot undergo conventional open surgery due to poor health or advanced age.
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Affiliation(s)
- Jianquan Chen
- Guangzhou University of Chinese Medicine, Guangzhou, PR China
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Tianhang Xuan
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Yao Lu
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Xinyuan Lin
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Zhouming Lv
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Maoshui Chen
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
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Slowinski J, Lucasti C, Maraschiello M, Kluczynski MA, Kowalski J, Hamill C. Minimally invasive spine surgery as treatment for persistent infectious lumbar spondylodiscitis: a systematic review and meta-analysis. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:1-8. [PMID: 35441095 PMCID: PMC8990387 DOI: 10.21037/jss-21-50] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/02/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Antibiotic resistant infectious spondylodiscitis (IS) can cause significant morbidity for patients. Open surgical techniques were previously the only option for patients who failed antibiotic therapy. However, advances in minimally invasive surgical techniques may provide a new alternative for some patients. METHODS A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify studies that reported inflammatory [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] and functional outcomes [visual analog scale (VAS)] for patients with antibiotic resistant IS treated with either minimally invasive or open surgery. Searches were preformed using PubMed, Embase, and Scopus from January 2015 to June 2021. Fourteen articles met inclusion criteria. One study was a Level III evidence study and the other 13 included studies were Level IV. RESULTS The minimally invasive surgery group showed significantly lower post-operative CRP and VAS pain scores and significantly higher post-operative ESR levels than the open group. All studies included were measured by the Downs and Black tool for potential bias. DISCUSSION This study showed that minimally invasive surgery is efficacious in the treatment of antibiotic resistant IS. These outcomes support minimally invasive surgery (MIS) as an effective alternative to previous open surgery techniques in certain patients after failed trails of antibiotic therapy.
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Affiliation(s)
- Joshua Slowinski
- Department of Orthopaedics, Jacob School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Christopher Lucasti
- Department of Orthopaedics, Jacob School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Mark Maraschiello
- Department of Orthopaedics, Jacob School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacob School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Joseph Kowalski
- Department of Orthopaedics, Jacob School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Christopher Hamill
- Department of Orthopaedics, Jacob School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
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Novel minimally invasive management of lumbar osteomyelitis: A case report. Int J Surg Case Rep 2022; 92:106878. [PMID: 35276431 PMCID: PMC8908219 DOI: 10.1016/j.ijscr.2022.106878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/22/2022] Open
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Endoscopic treatment of spondylodiscitis: systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1765-1774. [PMID: 35211807 DOI: 10.1007/s00586-022-07142-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 12/31/2021] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spondylodiscitis is a severe condition where standalone antibiotic therapy resolves most cases. In refractory infections, open surgery may aid with infection debulking. However, significant morbidity can occur. Nowadays, endoscopic approaches are emerging as an alternative. However, until now, only small-scale studies exist. Being so, we carried the first systematic review on spondylodiscitis endoscopic debridement indications, technique details, and outcomes. METHODS Search for all English written original studies approaching the spondylodiscitis endoscopic treatment was performed using PubMed and EBSCO host. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a pre-specified protocol was registered at PROSPERO (CRD42020183657). RESULTS Fourteen studies involving 342 participants were included for analysis. Data overall quality was fair. Indications for the endoscopic approach were poorly defined. The most consensual indication was refractory infection to conservative treatment. Spinal instability or neurological deficits were common exclusion criteria. All authors described similar techniques, and despite the frequent severe co-morbidities, procedure morbidity was low. Re-interventions were common. Microorganism identification varied from 54.2 to 90.4%. Treatment failure among studies ranged from 0 to 33%. Pain, functional status, and neurological deficits had satisfactory improvement after procedures. CONCLUSIONS The endoscopic debridement of spondylodiscitis seems to be an effective and safe approach for refractory spondylodiscitis. A novel approach with initial endoscopic infection debulking and antibiotic therapy could improve the success of spondylodiscitis treatment.
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Lai PJ, Wang SF, Tsai TT, Li YD, Chiu PY, Hsieh MK, Kao FC. Percutaneous Endoscopic Interbody Debridement and Fusion for Pyogenic Lumbar Spondylodiskitis: Surgical Technique and the Comparison With Percutaneous Endoscopic Drainage and Debridement. Neurospine 2022; 18:891-902. [PMID: 35000347 PMCID: PMC8752711 DOI: 10.14245/ns.2142640.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/08/2021] [Indexed: 12/18/2022] Open
Abstract
Objective Surgical treatment of severe infectious spondylodiskitis remains challenging. Although minimally invasive percutaneous endoscopic drainage and debridement (PEDD) may yield good results in complicated cases, outcomes of patients with extensive structural damage and mechanical instability may be unsatisfactory. To address severe infectious spondylodiskitis, we have developed a surgical technique called percutaneous endoscopic interbody debridement and fusion (PEIDF), which comprises endoscopic debridement, bonegraft interbody fusion, and percutaneous posterior instrumentation.
Methods Outcomes of PEIDF in 12 patients and PEDD in 15 patients with infectious spondylodiskitis from April 2014 to July 2018 were reviewed retrospectively. Outcome were compared between 2 kinds of surgical procedures.
Results Patients in PEIDF group had significantly lower rate of revision surgery (8.3% vs. 58.3%), better kyphosis angle (-5.73°±8.74 vs. 1.07°±2.70 in postoperative; 7.09°±7.23 vs. 0.79°±4.08 in kyphosis correction at 1 year), and higher fusion rate (83.3% vs. 46.7%) than those who received PEDD.
Conclusion PEIDF is an effective approach for treating infectious spondylodiskitis, especially in patients with spinal instability and multiple medical comorbidities.
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Affiliation(s)
- Po-Ju Lai
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sheng-Fen Wang
- Department of Anesthesiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yun-Da Li
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fu-Cheng Kao
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Zheng Q, Ying X, Jin Y, Zhu B, Shen J, Wang Y, Zheng M, Liu F. Treatment of single-segment suppurative spondylitis with the transforaminal endoscopic focal cleaning and drainage. J Spinal Cord Med 2021; 44:267-275. [PMID: 31180827 PMCID: PMC7952067 DOI: 10.1080/10790268.2019.1617921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: To evaluate the clinical value of the transforaminal endoscopic focal cleaning and drainage for suppurative spondylitis.Design: Retrospective study.Participants: Twenty-one patients with single-segment suppurative spondylitis.Interventions: All patients were treated with the transforaminal endoscopic focal cleaning and drainage.Outcome Measures: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before and after the operation. Visual analogue scale (VAS) was used to evaluate the relief of pain symptoms. Neurological function American Spinal Injury Association (ASIA) grade was used to evaluate the recovery of neurological function. The postoperative clinical efficacy of the patients was evaluated using the Kirkaldy-Willis functional scoring criteria. The stability of the spine and the recurrence of infection were evaluated by imaging data.Results: Postoperative bacteriological culture results showed positive in 15 cases and no bacteria growth in 6 cases. Besides, 16 cases were pathologically diagnosed. The ESR, CRP, and VAS scores at 2 weeks postoperatively and at the last follow-up were significantly improved compared with those at pre-operation. At the last follow-up, the clinical outcome was excellent in 17 cases, good in 3 cases, and fair in 1 case, according to the Kirkaldy-Willis functional scoring criteria; and the ASIA grade returned to normal. There was no significant difference in the Cobb angle between the last follow-up and the pre-operation. There was no recurrence of infection during the follow-up period.Conclusion: The transforaminal endoscopic focal cleaning and drainage is a minimally invasive, effective and safe surgical procedure for suppurative spondylitis.
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Affiliation(s)
- Qi Zheng
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Xiaozhang Ying
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China,Correspondence to: Xiaozhang Ying, Department of Orthopedics, Hangzhou Red Cross Hospital, No. 208, Huancheng East Road, Hangzhou, Zhejiang310003, People’s Republic of China. E-mail:
| | - Yanghui Jin
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Bo Zhu
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Jian Shen
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Yifan Wang
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Mingfeng Zheng
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Fei Liu
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
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Wu D, Sun J, Fan W, Yuan F. Unilateral or Bilateral Percutaneous Endoscopic Debridement and Lavage Treatment for Lumbar Spinal Tuberculosis. World Neurosurg 2020; 140:e73-e80. [PMID: 32344133 DOI: 10.1016/j.wneu.2020.04.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the clinical outcome between bilateral percutaneous endoscopic debridement and lavage (PEDL) and unilateral PEDL treatment for lumbar spine tuberculosis (LST). METHODS A total of 40 patients with LST who underwent either bilateral PEDL (group A) or unilateral PEDL (group B) were reviewed. Perioperative parameters were assessed by operative time, intraoperative fluoroscopy times, and days of postoperative continuous irrigation and vacuum drainage. Clinical outcomes were evaluated in the Oswestry Disability Index (ODI), visual analog scale (VAS), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). All patients were followed-up for at least 18 months after treatment. RESULTS The average operative time and intraoperative fluoroscopy time were increased in group A compared with those in group B. There was no statistical significance between the 2 groups in postoperative continuous irrigation and vacuum drainage days. The ESR and CRP curves in the 2 groups showed a similar trend during 18-month follow-up. The VAS and ODI in the 2 groups significantly decreased 6 and 18 months postsurgery. There was no significant difference in the incidence of complication between the 2 groups. CONCLUSIONS Two procedures yielded comparable and satisfactory results. Unilateral PEDL showed shorter operative time and decreased intraoperative fluoroscopy times compared with bilateral PEDL. We suggest the use of unilateral PEDL rather than bilateral PEDL in the treatment of LST.
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Affiliation(s)
- Dongying Wu
- Departments of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jun Sun
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Weimin Fan
- Departments of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Feng Yuan
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Zhou B, Kang YJ, Chen WH. Continuous Epidural Irrigation and Drainage Combined with Posterior Debridement and Posterior Lumbar Inter-Body Fusion for the Management of Single-Segment Lumbar Pyogenic Spondylodiscitis. Surg Infect (Larchmt) 2019; 21:262-267. [PMID: 31647391 DOI: 10.1089/sur.2019.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Purpose: To observe the clinical curative effect of continuous epidural irrigation combined with posterior debridement and posterior lumbar inter-body fusion with instrumentation for the therapy of single-segment lumbar pyogenic spongdylodiscitis. Methods: From June 2010 to November 2013, surgical treatment was performed in 18 patients with pyogenic spondylodiscitis. The surgical indications were progressive biomechanical instability, epidural abscesses, deterioration of neurologic status, and intractable back pain. All these patients received posterior decompression with posterior instrumentation, debridement of infected tissue, and inter-body fusion. Visual Analogue Scale (VAS) scores were used to assess clinical outcomes. The neural function was evaluated by the Frankel grading system. Laboratory and radiologic results were recorded during clinical follow-up for at least one year. Results: The average follow-up period was 18 months after the operation. The VAS scores decreased from an average of 7.1 points before the procedure to 2.6 points after operation. The neurologic deficits of all the patients were recovered to Frankel grade E. All of the examined laboratory parameters were normalized gradually. Imaging-documented fusion was achieved in each patient, and no implants failure was noted. No patients showed any evidence of recurrence or persistence of infection. Conclusion: In carefully selected patients, single-segment lumbar pyogenic spondylodiscitis can be cured successfully with continuous epidural irrigation and drainage combined with posterior debridement and posterior lumbar inter-body fusion. Instrumentation could provide immediate stability and reconstruction of the spine column, and the presence of instrumentation did not result in any persistence or recurrence of infection. Continuous epidural irrigation and drainage is an effective method facilitating the elimination of residual infection.
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Affiliation(s)
- Bin Zhou
- Spine Surgery Department, Second Xiangya Hospital of Central South University, Hunan Province, People's Republic of China
| | - Yi-Jun Kang
- Spine Surgery Department, Second Xiangya Hospital of Central South University, Hunan Province, People's Republic of China
| | - Wei-Hua Chen
- Spine Surgery Department, Second Xiangya Hospital of Central South University, Hunan Province, People's Republic of China
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Wang X, Zhou S, Bian Z, Li M, Jiang W, Hou C, Zhu L. Unilateral percutaneous endoscopic debridement and drainage for lumbar infectious spondylitis. J Orthop Surg Res 2018; 13:306. [PMID: 30509282 PMCID: PMC6276136 DOI: 10.1186/s13018-018-1009-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/19/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The treatment of lumbar infectious spondylitis is controversial. In this study, we attempted to demonstrate that unilateral percutaneous endoscopic debridement with physiologic saline and negative pressure drainage postoperatively may achieve a satisfactory result in lumbar infectious spondylitis. METHODS We retrospectively analyzed 17 patients with lumbar infectious spondylitis who underwent percutaneous endoscopic debridement and drainage (PEDD) through a posterolateral transforaminal approach. Each biopsy specimen was submitted without delay after surgery and examined for microorganisms and evaluated histopathologically. Patients were assessed by careful physical examination, MacNab criteria, Oswestry Disability Index (ODI), visual analog scale (VAS), regular serological tests, imaging studies for clinical function, and patient satisfaction. RESULTS Of the 17 patients, 14 (82.4%) had satisfactory relief of their back pain according to MacNab criteria at 1 week after PEDD. Three patients (17.6%) who had advanced infections with multilevel involvement and paraspinal abscesses underwent anterior debridement and autograft interbody fusion with instrumentation within 2 weeks. However, there were no other severe surgery-related complications. Causative bacteria were identified in most cases, and Staphylococcus aureus was the most prevalent strain. CONCLUSIONS Unilateral PEDD with physiological saline or empirical antibiotics did not disrupt lumbar stability and avoided the important intraspinal structures such as the dural sac and nerve roots. It not only had a high rate of identification of the causative pathogen, but also provided effective infection control and pain relief. PEDD may be a useful technique for treatment of lumbar infectious spondylodiscitis patients who have no severe deformities and are unable to undergo the conventional anterior surgery due to poor health or advanced age.
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Affiliation(s)
- Xuepeng Wang
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Shaobo Zhou
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Zhenyu Bian
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Maoqiang Li
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Wu Jiang
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Changju Hou
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Liulong Zhu
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
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Xu Z, Zheng Y. Percutaneous endoscopic debridement and irrigation for thoracic infections. ACTA ACUST UNITED AC 2018; 64:518-524. [PMID: 30304309 DOI: 10.1590/1806-9282.64.06.518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/05/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of percutaneous endoscopic debridement and irrigation for thoracic infections and to make an appropriate choice according to the patient's condition. METHODS. Thirty patients with thoracic infections who received surgical treatment from August 2014 to December2016 were retrospectively analyzed. There were 16 males and 14 females, aged from 41 to 90 years, with an average of 64.4 years. A total of 9 cases were treated with percutaneous endoscopic debridement and irrigation (minimal group), and 21 cases were treated with open debridement in combination with pedicle screw fixation (conventional group). Patients underwent follow-up for 1 month. General condition, operative index, laboratory results, and imaging features were recorded. RESULTS. Compared with the conventional group, there were more comorbidities in patients in the minimal group (8 cases in the minimal group, 10 cases in the conventional group, P=0.049), shorter hospital stay (10.1 + 2.26 days in the minimal group, 16.1 + 6.81 days in the conventional group, P=0.016), less bleeding volume (383.3 + 229.86ml in the minimal group, 90 + 11.18ml in the conventional group, P=0.000), lower VAS score at discharge (2.9 + 0.93 in the minimal group, 3.9 + 0.91 in the conventional group, P=0.013). There was no spinal instability case in the minimal group, 10 cases in the conventional group, P=0.013. There were significant differences. The C reaction protein prior to operation in the minimal group was 28.4±7.50mg/L. Compared with 45.1 + 15.78mg/L in the conventional group, P=0.005, it was lower. CONCLUSIONS. Percutaneous endoscopic debridement and irrigation are an effective surgery for treatment of thoracic infections, especially suitable for patients with comorbidities and poor general condition. However, for severe infection and spinal instability, we tend to choose open surgery in combination with fixation.
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Affiliation(s)
- Zhongyang Xu
- Jining No.1 people's Hospital, Jining Shi, Shandong Sheng, China
| | - Yanping Zheng
- Shandong University, Qilu Hospital, Jinan Shi, Shandong Sheng, China
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