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Comparison of CT-Guided needle biopsy versus percutaneous endoscopic debridement and drainage in pathogen identification and pain outcomes for spondylodiscitis patients: A systematic review and literature review CT引导下针穿活检与经皮内镜清创引流术在病原体识别和脊柱盘炎症患者疼痛疗效方面的比较：系统回顾和文献综述

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102854

Nischal Acharya , Joshua S. Kurtz , Kylie T. Callan , Gabrielle E.A. Hovis , Scarlett R.K. Mar , Alexander Lopez , Alvin Y. Chan , Hao-Hua Wu , Sohaib Z. Hashmi , Nitin N. Bhatia , Michael Y. Oh

Introduction

Spondylodiscitis (SD) is an infection of the intervertebral disc with involvement of the adjacent vertebral bodies. Diagnostic tests with CT-guided biopsy only provide a positive yield in 14%–48% of cases. Percutaneous endoscopic debridement and drainage (PEDD) has recently shown promise in the treatment of spondylodiscitis.

Research question

The purpose of this study is to determine differences in pathogen identification and clinical outcomes for PEDD versus CT-guided needle biopsy in SD patients.

Materials and methods

We conducted a systematic review of the literature using PRISMA guidelines to determine differences in positive microbiology results, perioperative complications, pain control, and long-term clinical outcomes for PEDD vs. CT-guided needle biopsy in SD patients.

Results

1078 studies were evaluated, 87 of which underwent full review. 15 studies met the inclusion and exclusion criteria, including 7 PEDD, 7 CT-guided biopsy, and 1 CT-guided biopsy vs. PEDD article, for a total of 192 PEDD patients and 604 CT-guided biopsy patients. We found 36.59% of CT-guided biopsy patients had positive microbiology results, compared to 84.38% of PEDD patients. No major perioperative complications occurred as a result of the PEDD procedure. Of the five PEDD studies that reported pain outcomes, greater than 80% of patients experienced relief after intervention.

Discussion and conclusion

These results suggest that PEDD may improve pathogen identification while simultaneously reducing pain compared to CT-guided needle biopsy in SD. Although current treatment guidelines recommend CT-guided biopsy, in patients with severe back pain and suspected SD, PEDD can be considered an alternative intervention.

导言椎间盘炎（SD）是椎间盘感染并累及邻近椎体的一种疾病。CT引导下的活检诊断测试仅能在14%-48%的病例中获得阳性结果。本研究旨在确定经皮内镜清创引流术（PEDD）与 CT 引导下针刺活检术在 SD 患者病原体识别和临床疗效方面的差异。材料和方法我们采用PRISMA指南对文献进行了系统性回顾，以确定PEDD与CT引导下针刺活检在SD患者微生物学阳性结果、围术期并发症、疼痛控制和长期临床结果方面的差异。15项研究符合纳入和排除标准，包括7篇PEDD文章、7篇CT引导活检文章和1篇CT引导活检与PEDD对比文章，共计192名PEDD患者和604名CT引导活检患者。我们发现，36.59% 的 CT 引导活检患者微生物学结果呈阳性，而 PEDD 患者的这一比例为 84.38%。PEDD手术未出现严重的围手术期并发症。这些结果表明，与CT引导的SD针活检相比，PEDD可提高病原体识别率，同时减轻疼痛。尽管目前的治疗指南推荐在 CT 引导下进行活检，但对于严重背痛和疑似 SD 的患者，PEDD 可被视为一种替代性干预方法。

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引用次数: 0

Minimally-invasive lateral thoracic and lumbar interbody fusion (LLIF) with expandable interbody cages – Considerations, complications & outcomes 使用可扩张椎间融合器的微创侧胸椎和腰椎椎间融合术（LLIF）--注意事项、并发症和结果

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102870

Martin N. Stienen , Gregor Fischer , Linda Bättig , Anand Veeravagu , Benjamin Martens

Introduction

Reports about lateral lumbar or thoracic interbody fusion (LLIF) using expandable interbody spacers are sparse.

Research question

To report our experience with the use of expandable spacers for LLIF.

Material and methods

We reviewed all consecutive LLIF patients with use of an expandable titanium interbody implant (ELSA® Expandable Integrated LLIF Spacer, Globus Medical Inc, PA (USA)) between September 2018 and January 2024.

Results

We identified 503 patients, in which we performed LLIF at 732 levels. In 63 patients (12.5%) and 70 levels (9.6%) an expandable spacer was used. The mean age was 61.4 years, 57.1% were females. LLIF was performed between T11/12 – L4/5 in the setting of fusion procedures (mono-/bisegmental (20; 28.6%), 3–7 segments (29; 41.4%); >7 segments (21; 30.0%)), of which 21 (33.3%), 20 (31.8%) and 22 (34.9%) were for traumatic, deformity/revision and other diagnoses. Surgery included release of the anterior longitudinal ligament in 30 cases (42.9%). Intraoperative adverse events (AEs) were noted in 2 (3.2%), postoperative AEs in 27 (42.9%) at discharge, 17 (27.0%) at 3 months and 14 (22.2%) at 12 months. Segmental sagittal Cobb angle changed from 1.3° (preoperative) to 13.0° at discharge (p < 0.001), 12.7° at 3 months (p < 0.001) and 13.3° at 12 months (p < 0.001). Functional outcome was excellent/good in 43 (68.3%; 5 missing) at 3 months and in 37 (58.7%; 10 missing) at 12 months.

Discussion and conclusion

The use of LLIF with an expandable spacer was safe, promoted solid fusion and enabled powerful correction of sagittal segmental Cobb angle, which was maintained during follow-up.

材料和方法我们回顾了 2018 年 9 月至 2024 年 1 月期间使用可膨胀钛椎间植入物（ELSA® 可膨胀一体化 LLIF 椎间间隔，Globus Medical Inc，宾夕法尼亚州（美国））的所有连续 LLIF 患者。其中 63 例患者（12.5%）和 70 个水平（9.6%）使用了可扩张间隔器。患者平均年龄为61.4岁，57.1%为女性。LLIF手术在T11/12-L4/5之间的融合手术中进行（单节段/双节段（20例；28.6%）、3-7节段（29例；41.4%）；7节段（21例；30.0%）），其中21例（33.3%）、20例（31.8%）和22例（34.9%）用于外伤、畸形/翻修和其他诊断。30例（42.9%）手术包括前纵韧带松解术。2例（3.2%）出现术中不良反应，27例（42.9%）在出院时出现术后不良反应，17例（27.0%）在3个月时出现术后不良反应，14例（22.2%）在12个月时出现术后不良反应。节段矢状面 Cobb 角度从术前的 1.3° 变为出院时的 13.0°（p <0.001）、3 个月时的 12.7°（p <0.001）和 12 个月时的 13.3°（p <0.001）。3个月时有43人（68.3%；5人缺失）的功能结果为优秀/良好，12个月时有37人（58.7%；10人缺失）的功能结果为优秀/良好。

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