DOI QR코드

DOI QR Code

Pyogenic Spondylodiscitis after Percutaneous Endoscopic Lumbar Discectomy

  • Choi, Kyeong-Bo (Department of Neurosurgery, Busan Wooridul Spine Hospital) ;
  • Lee, Choon-Dae (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Spine Hospital)
  • Received : 2010.04.21
  • Accepted : 2010.11.22
  • Published : 2010.11.28

Abstract

We reviewed 9 cases of pyogenic spondylodiscitis following percutaneous endoscopic lumbar discectomy (PELD). Microbiologic cultures revealed 6 causative organisms. Five patients were managed conservatively and four were treated surgically. The mean follow-up period was 20.6 months and the average length of hospitalization was 24 days. Radiological evidence of spinal fusion was noted and infection was resolved in all patients. Although PELD is a safe and effective procedure, the possibility of pyogenic spondylodiscitis should always be considered.

Keywords

Acknowledgement

Supported by : Wooridul Spine Foundation

References

  1. Abramovitz JN, Batson RA, Yablon JS : Vertebral osteomyelitis. The surgical management of neurologic complications. Spine (Phila Pa 1976) 11 : 418-420, 1986 https://doi.org/10.1097/00007632-198606000-00003
  2. Bircher MD, Tasker T, Crawshaw C, Mulholland RC : Discitis following lumbar surgery. Spine (Phila Pa 1976) 13 : 98-102, 1988 https://doi.org/10.1097/00007632-198801000-00023
  3. Blankstein A, Rubenstein E, Ezra E, Lokiec F, Caspi I, Horoszowski H : Disc space infection and vertebral osteomyelitis as a complication of percutaneous lateral discectomy. Clin Orthop Relat Res : 234-237, 1987
  4. Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, et al. : Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine (Phila Pa 1976) 33 : E508-E515, 2008 https://doi.org/10.1097/BRS.0b013e31817bfa1a
  5. Cohen SP, Larkin T, Abdi S, Chang A, Stojanovic M : Risk factors for failure and complications of intradiscal electrothermal therapy : a pilot study. Spine (Phila Pa 1976) 28 : 1142-1147, 2003
  6. Dimar JR, Carreon LY, Glassman SD, Campbell MJ, Hartman MJ, Johnson JR : Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976) 29 : 326-332; discussion 332, 2004 https://doi.org/10.1097/01.BRS.0000109410.46538.74
  7. Dullerud R, Nakstad PH : Side effects and complications of automated percutaneous lumbar nucleotomy. Neuroradiology 39 : 282-285, 1997 https://doi.org/10.1007/s002340050410
  8. Eismont FJ, Bohlman HH, Soni PL, Goldberg VM, Freehafer AA : Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Joint Surg Am 65 : 19-29, 1983 https://doi.org/10.2106/00004623-198365010-00004
  9. Fouquet B, Goupille P, Jattiot F, Cotty P, Lapierre F, Valat JP, et al. : Discitis after lumbar disc surgery. Features of "aseptic" and "septic" forms. Spine (Phila Pa 1976) 17 : 356-358, 1992 https://doi.org/10.1097/00007632-199203000-00019
  10. Ha KY, Shin JH, Kim KW, Na KH : The fate of anterior autogenous bone graft after anterior radical surgery with or without posterior instrumentation in the treatment of pyogenic lumbar spondylodiscitis. Spine (Phila Pa 1976) 32 : 1856-1864, 2007 https://doi.org/10.1097/BRS.0b013e318108b804
  11. Hanaoka N, Kawasaki Y, Sakai T, Nakamura T, Nanamori K, Nakamura E, et al. : Percutaneous drainage and continuous irrigation in patients with severe pyogenic spondylitis, abscess formation, and marked bone destruction. J Neurosurg Spine 4 : 374-379, 2006 https://doi.org/10.3171/spi.2006.4.5.374
  12. Jang JS, An SH, Lee SH : Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations. J Spinal Disord Tech 19 : 338-343, 2006 https://doi.org/10.1097/01.bsd.0000204500.14719.2e
  13. Katonis P, Tzermiadianos M, Papagelopoulos P, Hadjipavolu A : Postoperative infections of the thoracic and lumbar spine : a review of 18 cases. Clin Orthop Relat Res 454 : 114-119, 2007 https://doi.org/10.1097/01.blo.0000238807.64541.d3
  14. Kim WJ, Lim ST, Lee SH : Pyogenic psoas abscess and secondary spondylodiscitis as a rare complication of percutaneous endoscopic lumbar discectomy : a case report. Joint Dis Rel Surg 16 : 163-166, 2005
  15. Lee S, Kim SK, Lee SH, Kim WJ, Choi WC, Choi G, et al. : Percutaneous endoscopic lumbar discectomy for migrated disc herniation : classification of disc migration and surgical approaches. Eur Spine J 16 : 431-437, 2007 https://doi.org/10.1007/s00586-006-0219-4
  16. Lim JK, Kim SM, Jo DJ, Lee TO : Anterior interbody grafting and instrumentation for advanced spondylodiscitis. J Korean Neurosurg Soc 43 : 5-10, 2008 https://doi.org/10.3340/jkns.2008.43.1.5
  17. Mastronardi L, Rychlicki F, Tatta C, Morabito L, Agrillo U, Ducati A : Spondylodiscitis after lumbar microdiscectomy : effectiveness of two protocols of intraoperative antibiotic prophylaxis in 1167 cases. Neurosurg Rev 28 : 303-307, 2005 https://doi.org/10.1007/s10143-005-0404-7
  18. Quinones-Hinojosa A, Jun P, Jacobs R, Rosenberg WS, Weinstein PR : General principles in the medical and surgical management of spinal infections : a multidisciplinary approach. Neurosurg Focus 17 : E1, 2004
  19. Rohde V, Meyer B, Schaller C, Hassler WE : Spondylodiscitis after lumbar discectomy. Incidence and a proposal for prophylaxis. Spine (Phila Pa 1976) 23 : 615-620, 1998 https://doi.org/10.1097/00007632-199803010-00016
  20. Ruetten S, Komp M, Merk H, Godolias G : Use of newly developed instruments and endoscopes : full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforminal approach. J Neurosurg Spine 6 : 521-530, 2007 https://doi.org/10.3171/spi.2007.6.6.2
  21. Safran O, Rand N, Kaplan L, Sagiv S, Floman Y : Sequential or simultaneous, same-day anterior decompression and posterior stabilization in the management of vertebral osteomyelitis of the lumbar spine. Spine (Phila Pa 1976) 23 : 1885-1890, 1998 https://doi.org/10.1097/00007632-199809010-00018
  22. Silber JS, Anderson DG, Vaccaro AR, Anderson PA, McCormick P; NASS : Management of postprocedural discitis. Spine J 2 : 279-287, 2002 https://doi.org/10.1016/S1529-9430(02)00203-6
  23. Yeung AT, Tsou PM : Posterolateral endoscopic excision for lumbar disc herniation : Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 27 : 722-731, 2002 https://doi.org/10.1097/00007632-200204010-00009

Cited by

  1. Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications vol.9, pp.4, 2010, https://doi.org/10.1586/erd.12.23
  2. The evaluation of the clinical, laboratory and the radiological findings of the fifty-five cases diagnosed with tuberculous, Brucellar and pyogenic spondylodiscitis vol.3, pp.1, 2010, https://doi.org/10.4103/0976-3147.91925
  3. Laser-assisted Transforaminal Endoscopic Lumbar Discectomy: Technical Pearls for Prevention of Complications vol.2, pp.2, 2013, https://doi.org/10.25289/ml.2013.2.2.43
  4. Epidural Steroids After a Percutaneous Endoscopic Lumbar Discectomy vol.40, pp.15, 2010, https://doi.org/10.1097/brs.0000000000000990
  5. The Research Progress of Percutanous Endoscopic Lumbar Discectomy Treating Lumbar Vertebrae Disease vol.6, pp.2, 2016, https://doi.org/10.12677/md.2016.62009
  6. Direct Tubular Lumbar Microdiscectomy for Far Lateral Disc Herniation: A Modified Approach vol.8, pp.3, 2010, https://doi.org/10.1111/os.12263
  7. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases vol.51, pp.1, 2017, https://doi.org/10.4103/0019-5413.197520
  8. Acute Cauda Equina Syndrome after Percutaneous Transforaminal Endoscopic Discectomy vol.3, pp.2, 2010, https://doi.org/10.21182/jmisst.2018.00367
  9. Infectious Lesions of the Spine: Draft National Clinical Guidelines vol.16, pp.4, 2019, https://doi.org/10.14531/ss2019.4.63-76
  10. Complications and limitations of endoscopic spine surgery and percutaneous instrumentation vol.3, pp.1, 2020, https://doi.org/10.4103/isj.isj_27_19
  11. The effect of instrumentation staging on patient outcomes in pyogenic vertebral osteomyelitis: A systematic review vol.8, pp.None, 2010, https://doi.org/10.1016/j.xnsj.2021.100083