Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea.
Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
Pain Physician. 2017 Sep;20(6):E933-E940.
The incidence of spinal infection seems to be increasing in recent years. Percutaneous endoscopic debridement and drainage (PEDD) has become an effective alternative to extensive open surgery.
This study reviewed the charter of patients who received PEDD using 4 different approach methods to evaluate the clinical results.
An Institutional Review Board (IRB)-approved retrospective chart review.
University hospital inpatient referred to our pain clinic.
A retrospective patient chart analysis of PEDD procedures in spinal infections over a 7-year period was done for the evaluation of structural location, symptoms and signs, etiologic agents, and outcomes.
Seventeen patients (11 men and 6 women, mean age 70.4 ± 11.1 years) with spinal infections received PEDD. According to the structural localization of the spinal infections, 6 cases of spondylodiscitis alone, 5 cases of spondylodiscitis with a psoas abscess, one case of spondylodiscitis with an epidural abscess, 4 cases of spondylodiscitis with epidural and psoas abscesses, and one case of spondylodiscitis with a facet joint abscess were found. All patients had preoperative symptoms of unremitting backache and febrile sensation, and signs of paravertebral muscle tenderness and limitation of spine motion. The most common etiologic bacteria were Staphylococcus aureus. Most patients (14/17) improved; the 2 failed patients received a second PEDD after recurrence, and the other received open surgery without re-PEDD. Both the numeric rating scale and Oswestry disability index scores were significantly reduced after PEDD. No complications related to PEDD were found.
This study is limited by its retrospective design.
PEDD using 4 different routes brought immediate pain relief and reduced disability in treating spinal infections, especially in elderly patients with comorbid underlying disorders.Key words: Percutaneous discectomy, psoas abscess, spinal epidural abscess, spondylodiscitis, surgical endoscopy.
近年来，脊柱感染的发病率似乎呈上升趋势。经皮内镜清创引流术（PEDD）已成为广泛开放性手术的有效替代方法。
本研究回顾性分析了采用 4 种不同入路方法行 PEDD 的患者特征，以评估其临床疗效。
机构审查委员会（IRB）批准的回顾性图表审查。
大学医院住院患者转诊至我院疼痛科。
对 7 年间因脊柱感染行 PEDD 患者的病历进行回顾性分析，评估其结构定位、症状和体征、病因和结局。
17 例（11 例男性，6 例女性；平均年龄 70.4 ± 11.1 岁）脊柱感染患者接受了 PEDD。根据脊柱感染的结构定位，单纯椎间盘炎 6 例，椎间盘炎合并腰大肌脓肿 5 例，椎间盘炎合并硬膜外脓肿 1 例，椎间盘炎合并硬膜外和腰大肌脓肿 4 例，椎间盘炎合并小关节脓肿 1 例。所有患者术前均有持续性腰痛和发热感，且均有椎旁肌压痛和脊柱活动受限。最常见的病原菌为金黄色葡萄球菌。17 例患者中 14 例（82.4%）症状改善，2 例（11.8%）治疗失败，复发后再次行 PEDD，1 例（5.9%）改行开放性手术，未再次行 PEDD。所有患者术后数字评分量表和 Oswestry 残疾指数评分均显著降低。未发现与 PEDD 相关的并发症。
本研究存在一定局限性，因为它是回顾性设计。
经皮内镜不同入路治疗脊柱感染，尤其是老年合并基础疾病患者，可即刻缓解疼痛，减轻残疾。
经皮椎间盘切除术；腰大肌脓肿；脊柱硬膜外脓肿；椎间盘炎；内窥镜手术。
