Minimally invasive percutaneous endoscopic treatment for acute pyogenic spondylodiscitis following vertebroplasty.

Abstract

Acute pyogenic spondylodiscitis caused by percutaneous vertebroplasty is a rare complication. We present the first report of minimally invasive endoscopic treatment for acute spondylodiscitis caused by vertebroplasty. A 60-year-old female was transferred with the symptom of right hip flexion weakness for 1 day. The patient underwent a vertebroplasty procedure because of L3 osteoporotic compression fracture at other hospital 6 weeks ago. Physical examination, laboratory finding and magnetic resonance imaging revealed an acute pyogenic spondylodiscitis with right L2 nerve root palsy caused by compression of bone and cement after L3 body collapse. Percutaneous endoscopic procedures including needle biopsy, debridement, root decompression and drainage were performed. One week after endoscopic treatment, her symptoms of back pain and nerve palsy improved significantly. After endoscopic treatment, the patient underwent conservative treatment with appropriate antibiotics according to the bacterial culture test results. Six weeks postoperatively, she was pain free with no neurological deficits or signs of infection. Five months later, spontaneous fusion between L2 and L3 body was observed. We report a case treated with endoscopic procedure without open surgery for acute pyogenic spondylodiscitis following vertebroplasty.