Abstract

OBJECTIVES: To report clinical results of endoscopic surgery for pyogenic spinal osteomyelitis and spondylodiscitis and to evaluate the effectiveness of this procedure in treatment of pyogenic spinal infections. Summary of Background Data: Spinal osteomyelitis and spondylodiscitis is frequently associated with elderly and compromised patients. Pyogenic spinal infections have been increasing due to the development of medical treatment for patients with comorbid medical problems. Thus, patients with spinal osteomyelitis who need surgery may benefit from minimal invasive techniques that avoid the complications of more extensive open approaches. We performed thoracoscopic and retroperitoneoscopic and percutaneous endoscopic posterolateral spinal surgery in patients with pyogenic vertebral osteomyelitis and spondylodiscitis, attempting to reduce the morbidity attributable to standard open surgery. METHODS: The technique and results of minimally invasive thoracoscopic spinal surgery for pyogenic vertebral osteomyelitis and spondylodiscitis in eleven patients, including radical debridement and anterior spinal reconstruction, are presented. 3patients in thoracoscopic approach 5 patients in retroperitoneoscopic approach, 3pateints in percutaneous endoscopic approach. Preoperative antibiotic treatment had failed in all the patients. RESULTS: All patients showed immediate pain reduction after surgery. Spinal fusion was obtained in 11 patients. Average of CRP was 7.00 mg/dl before surgery and 2.1 mg/dl at postoperative 3week. Radical debridement and anterior spinal reconstruction are feasible via endoscopic approach. Standard thoracotomy or thoracolumbar approaches associated with high morbidity can be avoided, even for fusion across multiple levels. Conversion to open technique was not necessary in this study. There was no recurrence of infection or loss of reduction during the follow-up period. Operative time and blood loss of endoscopic technique were comparable to open technique. CONCLUSIONS: The cases clearly demonstrate the feasibility and efficacy of endoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis and spondylodiscitis. Debridement, decompression of the spinal canal, interbody fusion, and anterior spinal fixation can be performed via endoscopic approach.