title: Clinical outcome of posterolateral endoscopic surgery for pyogenic spondylodiscitis: results of 15 patients with serious comorbid conditions.
abstract: METHODS
  Clinical results of posterolateral endoscopic debridement and irrigation followed by percutaneous drainage for pyogenic spondylodiscitis were analyzed.
  
  
  OBJECTIVE
  To report clinical results of transforaminal endoscopic surgery for pyogenic spondylodiscitis and to evaluate the effectiveness of this procedure in treatment of pyogenic spinal infections.
  
  
  BACKGROUND
  Pyogenic spinal infections have been increasing due to the development of medical treatment for patients with comorbid medical problems. Common treatments for spinal infections are administration of antibiotics or surgical debridement with bone grafts. There have been no reports, however, regarding the clinical outcome of posterolateral endoscopic treatment for pyogenic spinal infections.
  
  
  METHODS
  Fifteen consecutive patients with pyogenic spondylodiscitis in the thoracic or lumbar spine were enrolled. Preoperative antibiotic treatment had failed in all the patients. The procedures consisted of posterolateral endoscopic debridement and irrigation followed by percutaneous drainage through single portal under the combination of local and intravenous anesthesia. Pain response using visual analog scale (VAS, 0-100 mm), inflammation parameters, and duration of antibiotic therapy were investigated. Radiologic evaluation focused on bony fusion, local kyphosis, disc height reduction, and abscess formation.
  
  
  RESULTS
  All patients showed immediate pain reduction after surgery. Averaged VAS for pain was 86 before surgery and 25 at postoperative 1 week. Average of CRP was 4.00 mg/dL before surgery and 1.88 mg/dL at postoperative 1 week. Averaged duration of antibiotics therapy was 3.7 weeks. Spinal fusion was obtained in 13 patients. Two patients with neurologic deficits due to epidural abscess returned to normal. Preoperative psoas abscess in 6 patients disappeared after surgery on MRI.
  
  
  CONCLUSIONS
  Posterolateral spinal endoscopic debridement and irrigation brought immediate pain reduction and good clinical results to patients who had comorbid medical problems and had pyogenic spondylodiscitis.
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. maito@med.hokudai.ac.jp
authors.forename: Manabu
authors.initials: M
authors.lastname: Ito
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Abumi
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kotani
authors.forename: Ken
authors.initials: K
authors.lastname: Kadoya
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D003646:Debridement; D015299:Discitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D004322:Drainage; D004724:Endoscopy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D010147:Pain Measurement; D010166:Palliative Care; D013492:Suppuration; D007507:Therapeutic Irrigation; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein