Clinical Outcomes Of Percutaneous Transforaminal Endoscopic Debridement Followed By Continuous Irrigation And Drainage For Lumbar Spondylodiscitis Were Analyzed

Objective: To report the clinical results of percutaneous transforaminal endoscopic surgery for lumbar spondylodiscitis,and to evaluate the effectiveness and safety of this procedure in treatment of lumbar spondylodiscitis.Methods:Retrospective analysis was performed on 15 consecutive patients with lumbar spondylodiscitis treated in the spinal surgery department of Taizhou People’s Hospital from August 2018 to August 2020.There were 5 males and 10 females,aged from 39 to79 years,with an average of 61 years.All patients underwent posterior lateral percutaneous foraminal debridement under local anesthesia.Continuous irrigation and drainage were performed for 1 week postoperatively through a double-lumen cannula.Visual analogue scale of low back pain(VAS,0-10 score),lumbar JOA score and lumbar ODI scale were used to evaluate clinical symptom.Inflammation indicators(white blood cells WBC,C-reactive protein CRP,erythrocyte sedimentation rate ESR)were used to evaluate patients’ infection status.X-rays and MRI were used to evaluate lumbar fusion,kyphosis,and changes in intervertebral height.Results: All the 15 patients were followed up from 6 to 30 months,with an average of 18 months.All patients showed immediate pain reduction after surgery.Averaged VAS of low back pain was 8.80±1.01 at preoperative and 2.06±1.28 at postoperative 1 week.Averaged ODI was 66.36 ±5.85 at preoperative and 24.60±5.60 at postoperative 1week.Averaged JOA was 11.33±1.95 at preoperative and 17.40±1.96 at postoperative1 week.There were statistically significant differences between preoperative and postoperative 1 week(P < 0.001)in three pairs of datas.The scores of the patients improved at postoperative 1 month,All the patients relieved from the low back pain and recovered normal activities at postoperative 3 months and 6 months.The improvement rate of lumbar JOA was more than 75%,and the clinical effect was excellent.There were no statistically differences in CRP and ESR between preoperative and postoperative 1week.The inflammatory indicators of 13 patients returned to normal at postoperative 1month,which was statistically significant compared with preoperative(P < 0.001).At postoperative 3 months,the inflammatory indicators of all patients came to normal,and no infection recurrence was observed at the last follow-up.The change of lumbar local kyphosis was 1-6°,with an average of 3.33±3.75°,The loss of intervertebral height was 0.42-7.05 mm,with an average of 2.74±2.00 mm.All the patients achieved spinal stability by the loss of intervertebral height,but no bony fusion was observed.There no obvious kyphosis of the spine or other related complications were found.Conclusion: Percutaneous transforaminal endoscopic debridement followed by continuous irrigation and drainage ccan quickly relieve patients’ low back pain and restore patients’ spinal function in a short term.At the same time,continuous intervertebral lavage can quickly and effectively control local infection and restore the stability and function of the spine.