Main Article Content
Abstract
Introduction: Spondylodiscitis (SD) is an infectious inflammation affecting the vertebrae, inter-vertebral discs, and surrounding structures, with increased prevalence post-COVID-19 due to factors like steroid use and immunocompromised conditions. Contrast-enhanced MRI is the standard imaging technique but has limitations, especially with negative blood cultures. Percutaneous endoscopic biopsy (PEB) has emerged as a promising alternative offering diagnostic accuracy, minimal radiation exposure, and therapeutic benefits.
Materials and Methods: A prospective study was conducted at a tertiary care spinal center from June 2021 to June 2022, with Institutional Review Board (IRB) approval. Inclusion criteria included patients with clinico-radiological diagnosis of SD, while exclusion criteria included patients with neurological deficits or radiological signs of spinal instability. Blood samples and intra-operative endoscopic samples were collected for various analyses. Pre-operative and post-operative evaluations involved VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) scores. Empirical antibiotics were administered and adjusted based on culture sensitivity reports. Follow- up included blood tests and MRI after 3 months, with specific monitoring for tuberculosis patients. PEBs were performed under local anesthesia, predominantly via the transforaminal approach.
Results: The study included 24 patients (14 males, 10 females) with an average age of 44.78 years. Preoperative VAS score was 7.77 ± 0.97, which significantly reduced to 3.78 ± 1.22 postoperatively (p=0.0002). ODI scores also improved significantly. The L4-L5 level was most commonly involved. Microbial identification was successful in 87.5% of cases, with Mycobacterium tuberculosis being the predominant pathogen. ESR and CRP levels normalized post-therapy, and only two patients required additional procedures.
Discussion: The post-COVID era has seen increased cases of SD due to overuse of steroids. PEB offers higher diagnostic yield compared to traditional methods like CT-guided biopsy. The minimally invasive nature of PEB is beneficial for immunocompromised patients, providing effective diagnosis and treatment with reduced risks. Limitations include small sample size and the need for specialized skills.
Conclusion: Endoscopic approaches provide better diagnostic yield and therapeutic benefits for treating spondylodiscitis compared to traditional methods.