Skip to main content

Advertisement

Log in

Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis

  • Original Article
  • Intervertebral disc (clinical)
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

The natural history of uncomplicated hematogenous pyogenic spondylodiscitis is self-limiting healing. However, a variable degree of bone destruction frequently occurs, predisposing the spine to painful kyphosis. Delayed treatment may result in serious neurologic complications. Early debridement of these infections by percutaneous transpedicular discectomy can accelerate the natural process of healing and prevent progression to bone destruction and epidural abscess. The purpose of this manuscript is to present our technique of percutaneous transpedicular discectomy (PTD), to revisit this minimally invasive surgical technique with stricter patient selection, and to exclude cases of extensive vertebral body destruction with kyphosis and neurocompression by epidural abscess, infected disc herniation, and foraminal stenosis. In a previously published report of 28 unselected patients with primary hematogenous pyogenic spondylodiscitis, the immediate relief of pain after PTD was 75%, and in the longterm follow-up, the success rate was 68%. Applying stricter patient selection criteria in a second series of six patients (five with primary hematogenous spondylodiscitis and one with secondary postlaminectomydiscectomy spondylodiscitis), all patients with primary hematogenous spondylodiskitis (5/5) experienced immediate relief of pain that remained sustained at 12–18 months follow-up. This procedure was not very effective, however, in the patient who suffered from postlaminectomy infection. This lack of response was attributed to postlaminectomydiscitis instability. The immediate success rate after surgery for unselected patients in this combined series of 34 patients was 76%. This technique can be impressively effective and the results sustained when applied in the early stages of uncomplicated spondylodiscitis and contraindicated in the presence of instability, kyphosis from bone destruction, and neurological deficit. The special point of this procedure is a minimally invasive technique with high diagnostic and therapeutic effectiveness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chew F, Kline MJ (2001) Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious discitis. Radiology 218(1): 211–214

    PubMed  CAS  Google Scholar 

  2. Cierney G, Mader JT, Penninck JJ (1985) A clinical staging system for adult osteomyelitis. Contemp Orthop 10: 17–37

    Google Scholar 

  3. Crow WN, Borowski AM, Hadjipavlou AG, Walser EM et al (1998) Percutaneous transpedicular automated nucleotomy for debridement of infected discs. J Vasc Interv Radiol 9: 161–165

    Article  PubMed  CAS  Google Scholar 

  4. Eismont FJ, Bohlman HH, Soni PL, Goldberg VM, Freehafer AA (1983) Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Joint Surg [Am] 65(1): 19–29

    CAS  Google Scholar 

  5. Emery SE, Chan DP, Woodward HR (1989) Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine 14: 284–291

    PubMed  CAS  Google Scholar 

  6. Fraser RD, Osti OL, Vernon-Roberts B (1989) Iatrogenic discitis: the role of intravenous antibiotics in prevention and treatment. An experimental study. Spine 14: 1025–1032

    Article  PubMed  CAS  Google Scholar 

  7. Frederickson B, Yuan H, Olans R (1978) Management and outcome of pyogenic vertebral osteomyelitis. Clin Orthop 131: 160–167

    PubMed  Google Scholar 

  8. Gebhard JS, Brugman JL (1994) Percutaneous discectomy for the treatment of bacterial discitis. Spine 19(7): 855–857

    Article  PubMed  CAS  Google Scholar 

  9. Gill K, Blumenthal SL (1993) Automated percutaneous discectomy. Longterm clinical experience with the nucleotome system. Acta Orth Scand 64: 30–33

    Article  Google Scholar 

  10. Haaker RG, Senkal M, Kielich T, Kramer J (1997) Percutaneous lumbar discectomy in the treatment of lumbar discitis. Eur Spine J 6(2): 98–101

    Article  PubMed  CAS  Google Scholar 

  11. Hadjipavlou A, Arya S, Crow WN, et al (1996) Percutaneous transpedicular biopsy of the spine. J Interv Radiol 11: 103–108

    Google Scholar 

  12. Hadjipavlou AG, Crow WN, Borowski A, Mader JT, Adesokan A, Jensen RE (1998) Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis. Am J Orth 27: 188–197

    CAS  Google Scholar 

  13. Hadjipavlou AG, Kambin P, Lander PH, et al (1999) Imaging-guided minimally invasive surgery for low back pain, sciatica and spinal infection. J Interv Radiol 14: 1–22

    Google Scholar 

  14. Hadjipavlou AG, Bergquist SC, Chen JW, Necessary JT, Muffoletto AJ (2000) Vertebral osteomyelitis. Current Treatment Options in Infect Dis 2: 226–237

    Google Scholar 

  15. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ (2000) Hamatogenous pyogenic spinal infections and their surgical management. Spine 25(13): 1668–79

    Article  PubMed  CAS  Google Scholar 

  16. Ivey M, Clark R (1985) Arthroscopic debridement of the knee for septic arthritis. Clin Orthop 199: 201–206

    PubMed  Google Scholar 

  17. Jackson RW (1985) The septic knee arthroscopic treatment. Arthroscopy 1: 194–197

    Article  PubMed  CAS  Google Scholar 

  18. Jelinek JS, Kransdorf MJ, Gray R et al (1996) Percutaneous transpedicular biopsy of vertebral body lesions. Spine 21(17): 2035–2040

    Article  PubMed  CAS  Google Scholar 

  19. Lucio E, Adesokan A, Hadjipavlou A, Crow W, Adegboyega PA (2000) Pyogenic spondylodiscitis: A radiologic pathologic and culture correlation study. Arch Pathol Lab Med 14: 712–716

    Google Scholar 

  20. Nagata K, Ohashi T, Ariyoshi M, Sonoda K, Imoto H, Inoue A (1988) Percutaneous suction aspiration and drainage for pyogenic spondylitis. Spine 23: 1600–1606

    Article  Google Scholar 

  21. Onik G, Shang Y, Maroon JC (1990) Automated percutaneous biopsy in postoperative discitis: a new method. AJNR 11: 391–393

    PubMed  CAS  Google Scholar 

  22. Sklar EML, Post MJD, Lebwohl NH (1993) Imaging of infection of lumbosacral spine. Neuroimaging 3: 577–590

    Google Scholar 

  23. Stringham DR, Hadjipavlou A, Dzioba RB, Lander P (1994) Percutaneous transpedicular biopsy of the spine. Spine 19: 1985–1991

    Article  PubMed  CAS  Google Scholar 

  24. Taylor TFK, Dooley BJ (1978) Antibiotics in the management of postoperative disc space infections. Aust NZ J Surg 48: 74–75

    Article  CAS  Google Scholar 

  25. Vinicoff PG, Gutschik E, Hansen SE, Karle A, Rieneck K (1998) CT-guided spinal biopsy in spondylodiscitis. [Article in Danish]. Ugeskr Laeger 5; 160(41): 5931–5934

    CAS  Google Scholar 

  26. Ward JC, Jeanneret B, Oehlschlegel C, Magerl F (1996) The value of percutaneous transpedicular vertebral bone biopsies for histologie examination: Results of an experimental histopathologic study comparing two biopsy needles. Spine21: 2484–2490

    Article  PubMed  CAS  Google Scholar 

  27. Watters WC 3rd, Khalil MA (1994) Percutaneous discectomy for disc space infections. J South Orthop Assoc 3(4); 283–289

    PubMed  Google Scholar 

  28. Weber M, Heller KD, Wirtz D, Zimmermann-Picht S, Keulers P, Zilkens KW (1998) Percutaneous CT-controlled puncture and drainage of spondylodiscitis — a minimally invasive method. [Article in German]. Z Orthop Ihre Grenzgeb 136(4): 375–379

    Article  PubMed  CAS  Google Scholar 

  29. Wirtz DC, Genius I, Wildberger JE, Adam G, Zilkens KW, Niethard FU (2000) Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis — an evaluation of 59 cases. Acta Orthop Trauma Surg 120(5–6): 245–251

    Article  CAS  Google Scholar 

  30. Wisneski RJ (1991) Infectious disease of the spine: Diagnostic and treatment considerations. Orthop Clin North Am 22: 491–501

    PubMed  CAS  Google Scholar 

  31. Yu WY, Siu C, Wing PC, et al (1991) Percutaneous suction aspiration for osteomyelitis. Report of two cases. Spine 16(2): 198–202

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. G. Hadjipavlou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hadjipavlou, A.G., Katonis, P.K., Gaitanis, I.N. et al. Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis. Eur Spine J 13, 707–713 (2004). https://doi.org/10.1007/s00586-004-0699-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-004-0699-z

Keywords

Navigation