Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis
Background: Percutaneous endoscopic discectomy (PED) has been reported to be an effective procedure and minimally invasive surgical therapy for various spinal pathologies. Objective: To evaluate the clinical outcome of patients with pyogenic spondylitis who were treated with PED. Methods: Twenty-fou...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-11-01
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| Series: | Journal of Orthopaedic Surgery |
| Online Access: | https://doi.org/10.1177/2309499019885446 |
| _version_ | 1819149720690360320 |
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| author | Mamoru Kono Masao Koda Tetsuya Abe Kousei Miura Katsuya Nagashima Kengo Fujii Hiroshi Kumagai Hiroshi Noguchi Toru Funayama Masashi Yamazaki |
| author_facet | Mamoru Kono Masao Koda Tetsuya Abe Kousei Miura Katsuya Nagashima Kengo Fujii Hiroshi Kumagai Hiroshi Noguchi Toru Funayama Masashi Yamazaki |
| author_sort | Mamoru Kono |
| collection | DOAJ |
| description | Background: Percutaneous endoscopic discectomy (PED) has been reported to be an effective procedure and minimally invasive surgical therapy for various spinal pathologies. Objective: To evaluate the clinical outcome of patients with pyogenic spondylitis who were treated with PED. Methods: Twenty-four patients with pyogenic spondylitis who underwent PED were evaluated for medical history, level of the affected intervertebral space, mode of onset, plain radiographs, epidural or psoas abscesses on MRI, results of blood and intraoperative sample cultures, preoperative C-reactive protein (CRP) level, time until postoperative CRP normalization (CRP < 0.3), and any additional surgery. Patients who underwent additional surgery and showed uncontrollable inflammation were considered to have “failed” PED for pyogenic spondylitis. To elucidate the factors that were significantly associated with a failure of PED for pyogenic spondylitis, statistical analyses were conducted by univariate analysis. Results: Control of inflammation was achieved in 19 of 24 patients (76%) after PED for pyogenic spondylitis. The remaining five patients failed to achieve infection control by PED. One such patient was not able to control the infection after PED, and another patient developed an epidural abscess 2 weeks after PED. Remaining three “failed” patients had exacerbations of their infections during the postoperative course and required additional surgery. Univariate analyses demonstrated that diabetes mellitus (DM; p = 0.05), hemodialysis due to DM-induced renal failure ( p = 0.02), concomitant malignant disease ( p = 0.09), and acute onset ( p = 0.05) were possibly correlated with PED failure. Stepwise logistic regression analysis revealed that hemodialysis due to DM-induced renal failure was an independent factor associated with PED failure ( p = 0.03). Conclusions: PED might be considered as one of the alternative therapeutic options before invasive radical surgeries for pyogenic spondylitis after failure of standard conservative therapy. Even by less invasive PED, pyogenic spondylitis patients with DM-hemodialysis showed poor outcome. |
| first_indexed | 2024-12-22T14:06:06Z |
| format | Article |
| id | doaj.art-24f966df18b944bbbb98e970eb717e10 |
| institution | Directory Open Access Journal |
| issn | 2309-4990 |
| language | English |
| last_indexed | 2024-12-22T14:06:06Z |
| publishDate | 2019-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Orthopaedic Surgery |
| spelling | doaj.art-24f966df18b944bbbb98e970eb717e102022-12-21T18:23:17ZengSAGE PublishingJournal of Orthopaedic Surgery2309-49902019-11-012710.1177/2309499019885446Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitisMamoru KonoMasao KodaTetsuya AbeKousei MiuraKatsuya NagashimaKengo FujiiHiroshi KumagaiHiroshi NoguchiToru FunayamaMasashi YamazakiBackground: Percutaneous endoscopic discectomy (PED) has been reported to be an effective procedure and minimally invasive surgical therapy for various spinal pathologies. Objective: To evaluate the clinical outcome of patients with pyogenic spondylitis who were treated with PED. Methods: Twenty-four patients with pyogenic spondylitis who underwent PED were evaluated for medical history, level of the affected intervertebral space, mode of onset, plain radiographs, epidural or psoas abscesses on MRI, results of blood and intraoperative sample cultures, preoperative C-reactive protein (CRP) level, time until postoperative CRP normalization (CRP < 0.3), and any additional surgery. Patients who underwent additional surgery and showed uncontrollable inflammation were considered to have “failed” PED for pyogenic spondylitis. To elucidate the factors that were significantly associated with a failure of PED for pyogenic spondylitis, statistical analyses were conducted by univariate analysis. Results: Control of inflammation was achieved in 19 of 24 patients (76%) after PED for pyogenic spondylitis. The remaining five patients failed to achieve infection control by PED. One such patient was not able to control the infection after PED, and another patient developed an epidural abscess 2 weeks after PED. Remaining three “failed” patients had exacerbations of their infections during the postoperative course and required additional surgery. Univariate analyses demonstrated that diabetes mellitus (DM; p = 0.05), hemodialysis due to DM-induced renal failure ( p = 0.02), concomitant malignant disease ( p = 0.09), and acute onset ( p = 0.05) were possibly correlated with PED failure. Stepwise logistic regression analysis revealed that hemodialysis due to DM-induced renal failure was an independent factor associated with PED failure ( p = 0.03). Conclusions: PED might be considered as one of the alternative therapeutic options before invasive radical surgeries for pyogenic spondylitis after failure of standard conservative therapy. Even by less invasive PED, pyogenic spondylitis patients with DM-hemodialysis showed poor outcome.https://doi.org/10.1177/2309499019885446 |
| spellingShingle | Mamoru Kono Masao Koda Tetsuya Abe Kousei Miura Katsuya Nagashima Kengo Fujii Hiroshi Kumagai Hiroshi Noguchi Toru Funayama Masashi Yamazaki Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis Journal of Orthopaedic Surgery |
| title | Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis |
| title_full | Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis |
| title_fullStr | Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis |
| title_full_unstemmed | Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis |
| title_short | Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis |
| title_sort | percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis |
| url | https://doi.org/10.1177/2309499019885446 |
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