Postoperative spondylodiscitis following transforaminal percutaneous endoscopic lumbar discectomy: clinical characteristics and preventive strategies

Introduction. We aimed to demonstrate the unique clinical characteristics and outcomes of spondylodiscitis after transforaminal percutaneous endoscopic lumbar discectomy (PELD), and we also discuss about adequate preventive methods of this unexpected complication. Methods. The medical records of 9821 consecutive cases treated with PELD between January 2001 and December 2009 were reviewed. All cases of postoperative infection were identified. The clinical course, infection type, laboratory results and treatment options for each case were available from their records. Results. Of the 9821 patients, 12 (0.12%) were identified as having postoperative infections, and in all these cases, the infection manifested as spondylodiscitis. Four patients were treated with only antibiotic therapy; two patients were treated with surgical debridement; and the remaining six patients who were unresponsive to the initial therapies finally required lumbar interbody fusion with posterior instrumentation surgery. The mean Oswestry Disability Index (ODI) improved from 60.4% +/- 19.4% to 29.3% +/- 15.4%. Based on the modified MacNab criteria, 7 of the 12 patients (58.3%) showed an excellent or good outcome. Conclusion. Postoperative spondylodiscitis following PELD is relatively rare. However, its clinical progression could be more rapid and more serious than that after open surgery. Therefore, thorough preventive strategies for postoperative spondylodiscitis are mandatory.