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Posterolateral full-endoscopic debridement and irrigation is effective in treating thoraco-lumbar pyogenic spondylodiscitis, except in cases with large abscess cavities

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Abstract

Purpose

To determine the efficacy and poor prognostic factors of posterolateral full-endoscopic debridement and irrigation (PEDI) surgery for thoraco-lumbar pyogenic spondylodiscitis.

Methods

We included 64 patients (46 men, 18 women; average age: 63.7 years) with thoracic/lumbar pyogenic spondylodiscitis who had undergone PEDI treatment and were followed up for more than 2 years. Clinical outcomes after PEDI surgery were retrospectively investigated to analyze the incidence and risk factors for prolonged and recurrent infection.

Results

Of 64 patients, 53 (82.8%) were cured of infection after PEDI surgery, and nine (17.2%) had prolonged or recurrent infection. Multivariate analysis demonstrated that significant risk factors for poor prognosis included a large intervertebral abscess cavity (P = 0.02) and multilevel intervertebral infections (P < 0.05).

Conclusion

PEDI treatment is an effective, minimally invasive procedure for pyogenic spondylodiscitis. However, a large intervertebral abscess space could cause instability at the infected spinal column, leading to prolonged or recurrent infection after PEDI. In cases with a large abscess cavity with or without vertebral bone destruction, endoscopic drainage alone may have a poor prognosis, and spinal fixation surgery could be considered.

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Acknowledgements

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hokkaido University Hospital, North-14, West-5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan

    Katsuhisa Yamada, Masahiko Takahata, Akira Iwata, Tsutomu Endo, Ryo Fujita, Hiroyuki Hasebe, Takashi Ohnishi, Hideki Sudo & Norimasa Iwasaki

  2. Department of Orthopaedic Surgery, Sapporo Endoscopic Spine Surgery Clinic, North-16, East-16, Higashi-Ku, Sapporo, Hokkaido, 065-0016, Japan

    Ken Nagahama

  3. Department of Spine and Spinal Cord Disorders, National Hospital Organization, Hokkaido Medical Center, Yamanote 5-7, Nishi-Ku, Sapporo, Hokkaido, 063-0005, Japan

    Manabu Ito

Authors
  1. Katsuhisa Yamada
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  2. Masahiko Takahata
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Correspondence to Katsuhisa Yamada.

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Yamada, K., Takahata, M., Nagahama, K. et al. Posterolateral full-endoscopic debridement and irrigation is effective in treating thoraco-lumbar pyogenic spondylodiscitis, except in cases with large abscess cavities. Eur Spine J 32, 859–866 (2023). https://doi.org/10.1007/s00586-022-07470-x

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  • DOI: https://doi.org/10.1007/s00586-022-07470-x

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