Percutaneous Drainage of Chronic Destructive Lumbar Osteomyelitis Abscess Via the Use of Bilateral Transpedicular Trocar Access.
BACKGROUND
Pyogenic spondylodiskitis is an infection of intervertebral disks and spinal vertebral bodies. Various minimally invasive approaches to the infected disk spaces/abscesses have been described for management of early stages of the infection. Patients with chronic occurrence present with extensive infection, neurologic deficits, and bone destruction. Such patients commonly have substantial medical comorbidities. Despite the increased risks of complications, they often are treated with open surgical approaches without minimally invasive options. We describe a bilateral transpedicular approach to vertebral body abscess in a chronically infected patient with intraoperative contiguous irrigation.


METHODS
We present 2 cases, a 58-year-old man and a 61-year-old man, both with a diagnosis of vertebral osteomyelitis. Images of lumbar spine showed epidural abscess and adjacent vertebral body destruction. Because of their poor clinical condition and chronicity of disease, these patients underwent percutaneous bilateral transpedicular approach.


CONCLUSIONS
Patients in poor health and with chronic vertebral osteomyelitis may benefit from minimally invasive percutaneous transpedicular drainage and irrigation of the abscess, representing a minimally invasive and effective treatment alternative for these patients.
Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA. Electronic address: timur.urakov@jhsmiami.org.
Timur M
TM
Urakov
University of Las Palmas de Gran Canaria, Las Palmas, Spain.
Amanda M
AM
Casabella
Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA; Department of Clinical Rehabilitation Medicine, University of Miami, Miller School of Medicine, Miami, Florida, USA.
Howard B
HB
Levene
D004322:Drainage / Q000295:instrumentation* / Q000379:methods*; D005471:Fluoroscopy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055013:Osteoarthritis, Spine / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery*; D013525:Surgical Instruments; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
Abscess; Chronic; Fluoroscopy; Minimally invasive; Osteomyelitis/diskitis; Percutaneous; Transpedicular