title: Fungal spinal infection treated with percutaneous posterolateral endoscopic surgery.
abstract: BACKGROUND
  Fungal infection in the spine is rare and its treatment is challenging. Conservative treatment with antifungal drugs often fails, with the result that surgical intervention is required in many cases. Since the general conditions of patients with fungal infections is bad due to their comorbid medical problems, surgical invasiveness should be minimized. We have reported the effectiveness of posterolateral endoscopic surgery in treating pyogenic and tuberculous spondylodiscitis. This study reports the clinical results of posterolateral endoscopic surgery in treating fungal spinal infection.
  
  
  METHODS
  Between 2001 and 2009 we used posterolateral endoscopic surgery to treat four patients with fungal spinal infection. All were males, three in their 50s, and one in his 70s. The levels of infection were L2/3 and L5/S1 in one patient each, and L3/4 in two patients. As for the Griffiths classification, there was one patient in class 1, two in class 2, and one in class 3. Postoperative follow-up periods ranged from 26 to 92 months. Treatment history before surgery, species of causative fungus, selection of antifungal drugs and their duration, blood examinations, subsidence of infection, radiographic changes of the spine, and various complications were all investigated.
  
  
  RESULTS
  All patients had been treated with broad-spectrum antibiotics followed by anti-methicillin-resistant Staphylococcus aureus drugs for more than several months by previous doctors. From cultures of the tissues taken during endoscopic surgery, Candida species were detected in three patients and Paecilomyces species in one. After endoscopic surgery, the patients were administered antifungal drugs for 3 months, except for one patient who had a side effect. All patients showed successful subsidence of infection at the final follow-up.
  
  
  CONCLUSIONS
  Fungal spinal infection occurred in patients with a lengthy use of broad-spectrum antibiotics and anti-methicillin-resistant Staphylococcus aureus drugs. Posterolateral endoscopic debridement and irrigation surgery successfully treated fungal spinal infection. This procedure is effective in treatment of fungal spinal infection with minimal invasiveness.
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Iwata
authors.affiliation: Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Spinal Reconstruction, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Abumi
authors.affiliation: Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Sudo
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kotani
authors.affiliation: Department of Orthopedic Surgery, Hokkaido Social Insurance Hospital, Sapporo, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shono
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
mesh_terms: D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000382:microbiology / Q000601:surgery*; D013166:Spondylitis / Q000382:microbiology / Q000601:surgery*