title: Minimally invasive endoscopic treatment for lumbar infectious spondylitis: a retrospective study in a tertiary referral center.
abstract: BACKGROUND
  Spinal infections remain a challenge for clinicians because of their variable presentation and complicated course. Common management approaches include conservative administration of antibiotics or aggressive surgical debridement. The purpose of this study was to evaluate the efficacy of percutaneous endoscopic debridement with dilute betadine solution irrigation (PEDI) for treating patients with lumbar infectious spondylitis.
  
  
  METHODS
  From January 2005 to July 2010, a total of 32 patients undergoing PEDI were retrospectively enrolled in this study. The surgical indications of the enrolled patients included single-level infectious spondylodiscitis, postoperative infectious spondylodiscitis, advanced infection with epidural abscess, psoas muscle abscess, pre-vertebral or para-vertebral abscess, multilevel infectious spondylitis, and recurrent infection after anterior debridement and fusion. Clinical outcomes were assessed by careful physical examination, Macnab criteria, regular serologic testing, and imaging studies to determine whether continued antibiotics treatment or surgical intervention was required.
  
  
  RESULTS
  Causative bacteria were identified in 28 (87.5%) of 32 biopsy specimens. Appropriate parenteral antibiotics for the predominant pathogen isolated from infected tissue biopsy cultures were prescribed to patients. Twenty-seven (84.4%) patients reported satisfactory relief of their back pain after PEDI. Twenty-six (81.3%) patients recovered uneventfully after PEDI and sequential antibiotic therapy. No surgery-related major complications were found, except 3 patients with transient paresthesia in the affected lumbar segment.
  
  
  CONCLUSIONS
  PEDI was successful in obtaining a bacteriologic diagnosis, relieving the patient's symptoms, and assisting in the eradication of lumbar infectious spondylitis. This procedure could be an effective alternative for patients who have a poor response to conservative treatment before a major open surgery.
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Yang
authors.forename: Tsai-Sheng
authors.initials: TS
authors.lastname: Fu
authors.affiliation: Department of Orthopaedic Surgery and Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. edaspine@gmail.com.
authors.forename: Hung-Shu
authors.initials: HS
authors.lastname: Chen
authors.forename: Yu-Hsien
authors.initials: YH
authors.lastname: Kao
authors.forename: Shang-Won
authors.initials: SW
authors.lastname: Yu
authors.forename: Yuan-Kun
authors.initials: YK
authors.lastname: Tu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D020802:Epidural Abscess / Q000382:microbiology / Q000601:surgery; D005260:Female; D005471:Fluoroscopy; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000453:epidemiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013166:Spondylitis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents