The role of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis.
METHODS
Case report, operative technique.


OBJECTIVE
Vertebral osteomyelitis is frequently associated with elderly and debilitated patients who have significant medical comorbidities. If surgical debridement is contemplated, an open anterior approach like a thoracotomy can be associated with significant complications in this patient population. Thus, patients with vertebral osteomyelitis who need surgery may benefit from minimal invasive techniques that avoid the complications of more extensive open approaches. We performed thoracoscopic spinal surgery in patients with pyogenic vertebral osteomyelitis, attempting to reduce the morbidity attributable to standard open thoracotomy surgery.


METHODS
The technique and results of minimally invasive thoracoscopic spinal surgery for pyogenic vertebral osteomyelitis in three patients, including radical debridement and anterior spinal reconstruction, are presented.


RESULTS
Radical debridement and anterior spinal reconstruction are feasible via endoscopic approach. Standard thoracotomy or thoracoabdominal 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 thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Debridement, decompression of the spinal canal, interbody fusion, and anterior spinal fixation can be performed via endoscopic approach.
Mückley
Thomas
T
Department of Surgery, Trauma Center Murnau, Murnau, Germany. T.Mueckley@gmx.de
Schütz
Tanja
T
Schmidt
Meic H
MH
Potulski
Michael
M
Bühren
Volker
V
Beisse
Rudolf
R
D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013131:Spine / Q000473:pathology / Q000601:surgery*; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed