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 pyogenic spondylodiscitis has not been sufficiently studied.

AIM: To evaluate the effectiveness of treating acute nonspecific lumbar spondylodiscitis by percutaneous drainage of the inflammatory focus with targeted antibiotic therapy compared with conventional empirical antibiotic therapy followed by surgical treatment.

METHODS: A single-center, retrospective, controlled, cohort pilot study analyzed qualitative data from 63 patients (33 women and 30 men, mean age 56.79 years) with primary nonspecific monosegmental (39 patients) and polysegmental (24 patients) lumbar spondylodiscitis. A total of 34 patients underwent empirical antibiotic therapy followed by open debridement, whereas 29 patients received early minimally invasive debridement with percutaneous drainage of the destroyed disc and psoas abscess followed by targeted antibiotic therapy. Vertebral involvement was assessed according to the Pola classification. Neurological status, laboratory parameters including bacteriological tests, duration of hospital stay, and findings of magnetic resonance imaging and computed tomography were evaluated. Functional status was assessed using the Visual Analog Scale for pain, the Rivermead Mobility Index, and the Oswestry Disability Index at baseline and at the end of treatment. Follow-up lasted at least 6 months after discharge.

RESULTS: In acute nonspecific vertebral osteomyelitis, early (within the first 24 hours of admission) percutaneous biopsy of the lesion with closed drainage, compared with empirical antibiotic therapy with subsequent surgery in cases of failure, increased pathogen verification from 41.1% to 89.7% (p < 0.01), reduced overall treatment duration from 71.1 ± 16.6 to 46.3 ± 18.3 days (p < 0.01), and decreased the risk of delayed segmental instability from 41.0% to 20.6% (p < 0.01), with comparable mortality, hospital stay duration, and patients’ functional status at treatment completion. The use of minimally invasive methods with targeted antibiotic therapy did not require any open procedures throughout the treatment period, whereas in the empirical therapy group, subsequent open drainage of abscesses and destruction sites was performed in 76.4% of cases.

CONCLUSION: Minimally invasive diagnostics and drainage of pathological foci are effective in treating nonspecific lumbar spondylodiscitis without neurological complications, including cases complicated by sepsis.