gms | German Medical Science

Objective: A conservative procedure may be indicated in spondylodiscitis without accompanying neurological deficits, bony destruction or abscessing. If antibiotic therapy does not result in reduction of the signs of infection, biopsy may be performed to determine pathogens. But false-negative results are obtained in up to 50%. If the infection proves to be resistant, surgical measures with dorsal or ventral debridement and additional stabilization are to be considered. The objective of this study was the evaluation of the full-endoscopic transforaminal operation with debridement, drainage and material harvesting in lumbar spondylodiscitis resistant to conservative therapy.

Methods: 47 patients with lumbar spondylodiscitis without neurological deficits, bony destruction or abscessing were treated from 2002 to 2004, 25 initially conservatively with antibiosis, 22 directly full-endoscopic transforaminale. In the conservative group, biopsy was performed in case of therapy resistance. All patients were treated with braces and antibiosis over 12 weeks, in addition to finding-dependent bed-rest. CRP values and MRI diagnostics were used as the main parameters of the infection status. 45 patients were followed until 6 months after completion of the healing phase.

Results: In the conservative group, 9 patients were found to be therapy resistant and underwent biopsy, 4x without proof of pathogen. In all, 9 patients (36%) required open operation with debridement and stabilization due to increase of infection. In the endoscopically-operated group, positive proof of pathogen was possible in 18 cases. Endoscopic revision was performed 4 times, an open operation twice (9%). No operative complications occurred. The mean time in hospital in the conservative group, excluding the open-operated patients, was 31 days, in the endoscopic group 13 days. The healing phase including reduction of the signs of infection was significantly shorter in the endoscopic group.

Conclusions: The full-endoscopic transforaminal procedure offers advantages over the purely conservative procedure in the treatment of lumbar spondylodiscitis with the cited indication. There is a lower rate of open operation, more rapid healing, reduced hospitalisation and better proof of pathogens. The procedure has a low rate of complications. Consideration may be given to whether the full-endoscopic procedure is indicated early in all such spondylodiscitis, as is comparably the case in arthroscopic field.