Early minimally invasive drainage in nonspecific lumbar spondylodiscitis

BACKGROUND: The effectiveness of minimally invasive puncture drainage of the destruction zone and paravertebral abscesses in nonspecific purulent spondylodiscitis has not been sufficiently studied to date.

AIM: To evaluate the effectiveness of treatment of acute nonspecific spondylodiscitis of the lumbar spine using percutaneous drainage and sanitation of the inflammatory focus with targeted antibacterial therapy in compare with traditional empirical antibacterial therapy followed by surgical treatment.

MATERIAL AND METHODS: In the controlled, single-center, pilot, experimental, retrospective cohort study examined the qualitative data of 63 patients. (33 women and 30 men, average age 56.79 years) with primary nonspecific monosegmental (39 patients) and polysegmental (24 patients) lumbar vertebral spondylodiscitis were retrospectively studied. 34 patients were treated using empirical antibacterial therapy followed by open sanitation, 29 ones received early minimally invasive percutaneous drainage of a destroyed disc and psoas abscess followed by targeted antibacterial therapy. 24 patients had a polysegmental lesion, 39 had a monosegmental lesion. The spondylodiscitis were classified in accordance with classification of E. Pola. The neurological status, laboratory parameters, incl. bacteriological, duration of inpatient treatment, MRI and CT data were studied. Functional status was assessed by VAS pain scale, the Rivermead index and the Oswestry questionnaire at the beginning and at the end of treatment. The followed up study was performed 6 months after discharge from the hospital.

RESULTS: In acute nonspecific osteomyelitis of the vertebrae, early (on the first day after admission) percutaneous biopsy of the lesion with its closed drainage in comparison with empirical antibacterial therapy with surgical treatment, in case of its ineffectiveness, provides an increase in the level of verification of the pathogen from 41.1% to 89.7% (p <0.01), a decrease in the total duration of treatment from 71.1±16.6 up to 46.3±18.3 days. (p <0.01) and a decrease in the risk of delayed segmental instability from 41.0% to 20.6% (p <0.01) with a comparable mortality rate, duration of inpatient treatment and functional status of patients by the time of completion of general treatment. The use of minimally invasive methods with targeted antibacterial therapy did not require open interventions in any case during the entire treatment period, while with empirical antibacterial therapy, subsequent open drainage of abscesses and foci of destruction was performed in 76.4% of cases.

CONCLUSION: Minimally invasive diagnosis and drainage of pathological focus is effective in the treatment of nonspecific neurologically intact lumbar spine spondylodiscitis, including those complicated by sepsis.