J Minim Invasive Spine Surg Tech.  2024 Apr;9(1):31-36. 10.21182/jmisst.2023.01137.

Full-Endoscopic Discectomy and Debridement for Iatrogenic Spondylodiscitis After a Lumbar Peritoneal Shunt

• Huang CL
• Huang JY
• Chen CM
• Lee JH

• KMID: 2562196
• DOI: http://doi.org/10.21182/jmisst.2023.01137

Abstract

Lumbar peritoneal shunt (LPS) is the standard treatment for nonobstructive hydrocephalus. Shunt infection, overdrainage, bleeding, and cerebrospinal fluid leaks have been reported as LPS complications. We present a 70-year-old man who developed iatrogenic spondylodiscitis 2 weeks after LPS placement, experiencing severe back pain and neurological deficits. Despite the empiric antibiotics, his symptoms persisted. The patient underwent fully endoscopic debridement and drainage (FEDD) to address the infection without LPS removal. After the procedure, the patient experienced a significant reduction in pain. Even though pathogen cultures were negative, the empiric antibiotic treatment continued for 6 full weeks. The patient was able to ambulate with a thoracolumbar orthosis due to the lumbar kyphotic deformity. FEDD, in conjunction with effective antibiotics, offers rapid pain relief and functional improvement in iatrogenic spondylodiscitis, even with LPS placement. However, FEDD may not correct spinal deformities and is unsuitable for advanced spinal disease or instability. Early detection of spondylodiscitis is crucial for improved outcomes.

Keyword

Iatrogenic disease; Cerebrospinal fluid shunts; Lumbar vertebrae; Discitis; Endoscopy; Debridement