A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients.
This study evaluates the safety and effectiveness of computed tomography- (CT-) assisted endoscopic surgery in the treatment of infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients. From October 2006 to March 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under local anesthesia, and 13 lesions from 13 patients on the thoracic or upper lumbar spine were selected for evaluation. A CT-guided catheter was placed before percutaneous endoscopic surgery as a guide to avoid injury to visceral organs, major vessels, and the spinal cord. All 13 patients had quick pain relief after endoscopic surgery without complications. The bacterial culture rate was 77%. Inflammatory parameters returned to normal after adequate antibiotic treatment. Postoperative radiographs showed no significant kyphotic deformity when compared with preoperative films. As of the last follow-up visit, no recurrent infections were noted. Traditional transthoracic or diaphragmatic surgery with or without posterior instrumentation is associated with high rates of morbidity and mortality, especially in elderly patients, patients with multiple comorbidities, or immunocompromised patients. Percutaneous endoscopic surgery assisted by a CT-guided catheter provides a safe and effective alternative treatment for infectious spondylodiscitis of the thoracic and upper lumbar spine.
Department of Orthopedic Surgery, Show Chwan Memorial Hospital, No. 542, Section 1, Zhongshan Road, Changhua City, Changhua County 500, Taiwan.
Hsin-Chuan
HC
Chen
Department of Orthopedics, Tainan Municipal An-Nan Hospital-China Medical University, No. 66, Section 2, Changhe Road, Annan District, Tainan City 709, Taiwan ; Department of Bioscience Technology, College of Science, Chung Yuan Christian University, No. 200 Chung Pei Road, Chung Li District, Taoyuan City 320, Taiwan ; Department of Sports Medicine, College of Health Care, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung 404, Taiwan.
Teng-Le
TL
Huang
Department of Orthopedic Surgery, China Medical University Hospital, No. 2 Yuhder Road, North District, Taichung 404, Taiwan ; School of Medicine, China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung 404, Taiwan.
Yen-Jen
YJ
Chen
Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung 407, Taiwan ; Department of Early Childhood Care and Education, Jen-Teh Junior College of Medicine, Nursing and Management, No. 79-9 Sha-Luen Hu, Xi-Zhou Li, Hou-Loung Town, Miaoli County 356, Taiwan.
Hsi-Kai
HK
Tsou
School of Medicine, China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung 404, Taiwan ; Department of Radiology, China Medical University Hospital, No. 2 Yuhder Road, North District, Taichung 404, Taiwan.
Wei-Ching
WC
Lin
Department of Orthopedic Surgery, China Medical University Hospital, No. 2 Yuhder Road, North District, Taichung 404, Taiwan ; China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung 404, Taiwan.
Chih-Hung
CH
Hung
Department of Orthopedic Surgery, China Medical University Hospital, No. 2 Yuhder Road, North District, Taichung 404, Taiwan ; School of Medicine, China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung 404, Taiwan.
Chun-Hao
CH
Tsai
Department of Orthopedic Surgery, China Medical University Hospital, No. 2 Yuhder Road, North District, Taichung 404, Taiwan ; School of Medicine, China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung 404, Taiwan.
Horng-Chaung
HC
Hsu
Department of Orthopedic Surgery, China Medical University Hospital, No. 2 Yuhder Road, North District, Taichung 404, Taiwan ; School of Chinese Medicine, College of Chinese Medicine, China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung 404, Taiwan.
Hsien-Te
HT
Chen
D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000276:immunology / Q000473:pathology / Q000601:surgery; D015299:Discitis / Q000276:immunology* / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods