J Minim Invasive Spine Surg Tech.  2023 Oct;8(2):171-176. 10.21182/jmisst.2023.00983.

Transforaminal Full-Endoscopic Lumbar Discectomy for Lumbar Pyogenic Discitis: A Review

• Kimura T
• Ohara Y
• Kikuchi N
• Nakajima Y

• KMID: 2562170
• DOI: http://doi.org/10.21182/jmisst.2023.00983

Abstract

Pyogenic discitis can cause significant back pain, neurological complications, and spinal deformities. An early and accurate diagnosis of pyogenic discitis is crucial for its effective management. Magnetic resonance imaging is the gold standard for the diagnosis of pyogenic discitis. Hematologic markers such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein level are also helpful in monitoring disease progression. Furthermore, blood culture is essential for identifying the causative bacteria and selecting the antibiotic to be used. Biopsies are useful for identifying the causative bacteria when blood cultures are negative or when antibiotics are not sufficiently effective. While open biopsy or computed tomography-guided biopsy has conventionally been used for this purpose, recently, transforaminal full-endoscopic biopsies have been used to detect the causative bacteria in pyogenic discitis. Endoscopy can be used to obtain sufficient intervertebral disc samples with direct visualization, which increases the detection rate of causative bacteria and has been reported to be effective in relieving back pain through decompression for pyogenic disc space. However, the effectiveness of endoscopic surgery might be limited in cases of advanced infection or extensive bone destruction. In such situations, open surgery with anterior reconstruction using minimally invasive techniques may be preferred. Although it has its limits, transforaminal full-endoscopic discectomy has emerged as a standard method for identifying the causative bacteria in pyogenic discitis. It also has a high therapeutic effect.

Keyword

Pyogenic discitis; Spondylodiscitis; Discectomy; Full endoscopy; Transforaminal approach; Lavage; Biopsy; Debridement