RESUMEN
Objective:To access the feasibility and efficacy of percutaneous endoscopic debridement (PED) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis.Methods:49 patients (male 29, female 20), aged 51.2±13.9 years (range 19-81 years), who were diagnosed with lumbar pyogenic spondylodiscitis and received PED with PPSF in Orthopedic Department, Sun Yat-Sen Memorial Hospital and Zhuhai People's Hospital from January 2014 to March 2017, were retrospectively reviewed. The patients were operated in the prone position with the infected locus thoroughly debrided, vertebrae fixed and clinical outcomes were assessed by observing the changes of complaining symptoms, laboratory parameters, clinical functional scores (American Spinal Injury Association impairment scale, AIS; visual analog scale, VAS; Oswestry disability index, ODI) and imaging studies during perioperative and follow-up stages.Results:The mean operative time was 110.1±19.8 min (80-165 min), with intra-operative blood loss 47.8±20.6 ml (range 20-120 ml). All patients reported relief of back pain. Causative pathogens were identified in 36 of 49 biopsy specimens, with staphylococcal bacteria being the most prevalent strain (accounting for 50.0%). During 3-12 months' follow-up, 95.9% (47/49) patients' infection was well-controlled. At 3 month post-operative, C-reactive protein declined from 62.1±37.2 mg/L to 7.5±5.8 mg/L, white blood cell declined from (14.2±3.9)×10 9/L to (6.2±1.1)×10 9/L, ESR declined from 90.3±37.4 mm/1 h to 16.9±7.2 mm/1 h, and the values at 3 months post-operative had significant difference compared with values at pre-operative ( t=10.15, P<0.001; t=13.49, P<0.001; t=13.82, P<0.001). Spontaneous fusion was observed among 56.8% (21/37) of the patients during long-term radiological follow-ups (more than 1.5 years). At the last follow-up, the VAS declined from 7.4±0.6 points pre-operative to 0.5±0.3 post-operative, ODI declined from 78.2%±9.1% pre-operative to 14.0%±8.6% post-operative, and the values at the last follow-up had significant difference compared with values at pre-operative ( t=72.00, P<0.001; t=35.89, P<0.001). There were 38 cases of AIS E, and 11 cases of AIS D at pre-operative, while 43 cases of AIS E and 6 cases of AIS D. However, there were 11 patients developed post-operative complications, among whom 2 with recurrent infection, 2 with secondary neurological impairment. Conclusion:PED combined with PPSF effectively eliminated infected locus, stabilized the affected vertebrae, improved patients' clinical outcomes with small trauma, thereby offering an alternative for the treatment of lumbar pyogenic spondylodiscitis.