Percutaneous transpedicular management of discitis.
OBJECTIVE
To present the technique of percutaneous transpedicular biopsy and debridement of discs in diagnosis and management of discitis.


METHODS
Fifteen patients underwent disc biopsy through a transpedicular approach with local anesthesia and fluoroscopic guidance. An attempt was made to debride the disc as much as possible. A surgical vacuum drain was deployed through the transpedicular tract when there was persistent drainage.


RESULTS
Fifteen patients underwent percutaneous transpedicular disc biopsy and debridement of disc for suspected discitis. Three patients underwent biopsy only and 12 underwent percutaneous discectomy. Six patients had at least one positive culture. Eight patients who underwent discectomy had immediate improvement of pain or neurologic symptoms, obviating emergency surgical debridement of the disc. Four patients did not improve and underwent surgical debridement and fusion.


CONCLUSIONS
Transpedicular biopsy of the disc is an effective technique for adequate tissue retrieval and diagnosis of discitis. Adequate debridement in selected patients with antibiotic therapy may be definitive. Epidural extension of discitis and massive vertebral destruction precludes percutaneous treatment.
Arya
S
S
Department of Radiology, University of Texas Medical Branch, Galveston 77555, USA.
Crow
W N
WN
Hadjipaviou
A G
AG
Nauta
H J
HJ
Borowski
A M
AM
Vierra
L A
LA
Walser
E
E
D000328:Adult; D000768:Anesthesia, General; D000772:Anesthesia, Local; D001706:Biopsy / Q000379:methods; D003131:Combined Modality Therapy; D003646:Debridement; D015299:Discitis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D017587:Diskectomy, Percutaneous / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013904:Thoracic Vertebrae