Clinical outcomes of Percutaneous Endoscopic Debridement and Drainage combined with Percutaneous Pedicle Screw Fixation for the treatment of Infective Spondylodiscitis

Abstract Background: The morbidity of infectious spondylitis is increasing year by year in the elderly. Due to difficulties in coping with open surgery, we aim at presenting a treatment method for infectious spinal inflammation by the combination of Percutaneous Endoscopic Discectomy and Drainage (PEDD) and Percutaneous Pedicle Screw Fixation (PPSF) which obtained satisfactory outcomes in this study.Method: We have retrospectively analyzed 33 patients who had suffered from lumbar infectious spondylitis and undergone PEDD combined with the PPSF treatment. Biopsy specimen was taken from each of them during their operation and the specimen was submitted without delay for microculture. The dynamic change of patient clinical symptoms and their satisfaction degree were assessed by careful physical examination, regular serologic test, imaging study, Odom’s criteria, Frankel score, and visual analog scale (VAS).Result: Among the 33 patients, 22 (66.7%) had excellent symptom relief and the remaining 11 (33.3%) had good symptom relief after PEDD treatment according to Odom’s criteria. Additionally, PPSF was performed on 5 patients in the second stage, and yielded satisfactory result. There were no severe surgery-related complications. The microculture from 24 patients（72.7%）obtained from the operation were positive.Conclusion: PEDD and PPSF were under the influence of local anesthesia, which had lower requirements of patients’ general condition comparing to the traditional open surgery. In addition, PEDD obtained higher positive rate of microorganisms cultured comparing to other minimally invasive methods. PPSF was performed at the second stage to alleviate pain and further improve vertebral stability.