Identifying pathogens of spondylodiscitis: percutaneous endoscopy or CT-guided biopsy.
Identifying offending pathogens is crucial for appropriate antibiotic administration for infectious spondylitis. Although computed tomography (CT)-guided biopsy for bacteriologic diagnosis is a standard procedure, it has a variable success rate. Some reports claim percutaneous endoscopic discectomy and drainage offer a sufficient amount of tissue for microbiologic examination and easy application. We therefore compared the diagnostic value of CT guidance with that of endoscope guidance in 52 patients with suspected infectious spondylitis. Twenty patients underwent percutaneous endoscopic discectomy and drainage by an orthopaedic surgeon and the other 32 patients underwent CT-guided biopsies by a radiologist. Patients were followed a minimum of 12 months after treatment. Culture results of the biopsy specimens were recorded. Causative bacteria were identified more frequently with percutaneous endoscopy than in CT-guided biopsy (18 of 20 [90%] versus 15 of 32 [47%]). We observed no biopsy-related complications or side effects in either group. The data suggest percutaneous endoscopic discectomy and drainage yield higher bacterial recovery rates than CT-guided spinal biopsy.


METHODS
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Yang
Shih-Chieh
SC
Department of Orthopedic Surgery, E-DA Hospital, I-Shou University, Kaohsiung , Taiwan.
Fu
Tsai-Sheng
TS
Chen
Lih-Huei
LH
Chen
Wen-Jer
WJ
Tu
Yuan-Kun
YK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015299:Discitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology*; D017587:Diskectomy, Percutaneous / Q000379:methods*; D004322:Drainage; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed