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Percutaneous endoscopic discectomy and drainage for infectious spondylitis

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Abstract

Fifteen patients with infectious spondylitis were treated by percutaneous endoscopic discectomy and drainage (PEDD) and associated appropriate parenteral antibiotics. Infectious spondylitis was diagnosed clinically, on the basis of elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, and on roentgenographic and magnetic resonance imaging (MRI) findings. Causative bacteria were identified in 13 (86.7%) of 15 biopsy specimens. Systemic antibiotics were administered according to sensitivity analyses of pathogens. All patients reported immediate back pain relief except for two, who required anterior debridement and fusion one week and two weeks later, respectively. Two other patients with recurrent infection and intractable pain underwent surgical intervention at one month and eight months after PEDD, respectively. The remaining 11 patients recovered uneventfully after full-course, specific, antimicrobial therapy. No surgery related complications or side effects were observed during at least 12 months of follow-up. In conclusion, PEDD can provide retrieval of sufficient specimens and has high diagnostic efficacy, thereby enabling prompt and appropriate antibiotic therapy to the offending pathogens. It can be considered an effective alternative for treating uncomplicated spondylitis.

Résumé

Résumé 15 patients présentant une discospondylite infectieuse ont été traités par chirurgie percutanée, drainage et antibio thérapie parentérale adaptée. Le diagnostic de discospondylite infectieuse repose sur l’élévation de la vitesse de sédimentation et de la protéine C réactive, le diagnostic est également confirmé par l’étude radiographie et l’IRM. On a pu faire le diagnostic bactériologique dans 13 cas (86,7%) sur 15 biopsies. L’antibio thérapie a été mise en place en fonction de l’antibiogramme. Tous les patients ont bénéficié d’une disparition rapide de la douleur en dehors de deux patients qui ont nécessité un traitement chirurgical par voie antérieure avec greffe à une et deux semaines après le début du traitement. Deux autres patients présentant une récidive de l’infection, avec récidive des douleurs ont nécessité une reprise chirurgicale à un et huit mois, les 11 patients restant ayant été guéris après l’antibio thérapie. Nous n’avons pas à déplorer de complications secondaires à la chirurgie, dans les 12 mois pendant lesquels nous avons suivis les patients. Le drainage et la chirurgie percutanée est un traitement efficace pour ces sujets. Il permet une antibio thérapie adaptée et, constitue pour nous, une alternative de choix.

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Acknowledgments

S.-C.Y performed the surgery, prepared this article, and reviewed the references; T.-S.F. performed the surgery, designed the study, and analysed the data; P.-L.L., C.-C.N., L.-H.C. and W.-J.C. revised the article for intellectual content.

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Correspondence to Tsai-Sheng Fu.

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Yang, SC., Fu, TS., Chen, LH. et al. Percutaneous endoscopic discectomy and drainage for infectious spondylitis. International Orthopaedics (SICOT) 31, 367–373 (2007). https://doi.org/10.1007/s00264-006-0188-6

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  • DOI: https://doi.org/10.1007/s00264-006-0188-6

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