Minimally invasive percutaneous endoscopic discectomy and drainage for infectious spondylodiscitis.
Minimally invasive percutaneous endoscopic discectomy and drainage for infectious spondylodiscitis.
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DOI：
10.4103/2319-4170.112742
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发表时间：
2013-07-01
影响因子：
5.5
通讯作者：
Chen, Wen-Jer
中科院分区：
文献类型：
--
作者：
Fu, Tsai-Sheng;Chen, Lih-Hui;Chen, Wen-Jer
治疗感染性脊柱炎的主要目标是做出准确的诊断，分离致病微生物，并根据培养数据开出有效的抗生素治疗。诊断不需要对负责微生物进行阳性培养，尽管这对成功治疗和防止进一步发病极其重要。手术干预通常用于对抗生素治疗无反应的病例，以及出现进行性脊柱畸形或不稳定、硬膜外脓肿或神经功能障碍的患者。然而，围手术期并发症的发生率在老年患者或一般情况较差的患者中尤其增加。随着内窥镜仪器和技术的改进，我们的临床经验表明，通过微创经皮内窥镜清创可以成功地治疗脊柱感染。直接内窥镜观察和从感染区域收集足够数量的样本以进行微生物检查通常是可能的。本文总结了经皮内窥镜下腰椎间盘摘除引流术(PEDD)在治疗腰椎炎中的诊断和治疗价值。我们的临床循证调查表明，PEDD可以提供足够的标本检索，并具有很高的诊断效率，从而能够对违规病原体进行及时和敏感的抗生素治疗。我们认为PEDD是治疗感染性脊柱炎的有效选择，在某些病例中应考虑在广泛的前路手术之前进行。这种方法特别适合脊椎感染早期或病情严重的患者。
The primary goals for treating infectious spondylodiscitis are to make an accurate diagnosis, isolate the causative organism, and prescribe effective antibiotic therapy based on the culture data. A positive culture of the responsible organism is not required for diagnosis, although it is extremely important for successful treatment and prevention of further morbidity. Surgical intervention is usually reserved for cases that are unresponsive to antibiotic therapy and for patients who have developed progressive spinal deformity or instability, epidural abscesses, or neurological impairment. However, the incidence of perioperative morbidity is particularly increased in elderly patients or in those with poor general condition. With improved endoscopic instruments and techniques, our clinical experiences demonstrate that spinal infections can be successfully treated by minimally invasive percutaneous endoscopic debridement. Direct endoscopic observation and collection of sufficient quantities of samples for microbiological examinations from the infected region are usually possible. This article summarizes the diagnostic and therapeutic values of percutaneous endoscopic discectomy and drainage (PEDD) used to treat patients with spondylodiscitis. Our clinical evidence-based survey suggests that PEDD can provide adequate retrieval of specimens and has high diagnostic efficacy, thereby enabling prompt and sensitive antibiotic therapy to the offending pathogens. We propose that PEDD is an effective alternative for treating infectious spondylodiscitis and should be considered prior to extensive anterior surgery in selected cases. This method is particularly suitable for patients with early-stage spinal infection or serious medical conditions.