Minimally invasive surgery for the treatment of thoraco lumbar pyogenic spondylodiscitis: indications and outcomes.

Abstract. – OBJECTIVE: Pyogenic spondylodis- citis (PS) is a non-specific infection affecting in- tervertebral disks and adjacent vertebral bodies. Once considered a rare condition in developed countries, the incidence of PS has been increas- ing alarmingly and still represents a challenge for clinicians and orthopedic surgeons. New minimal- ly invasive techniques have been proposed but the proper indications for these different approaches remain controversial. The aim of this study was to describe the available minimally invasive surgical techniques and to evaluate their proper indications through a review of recent literature. MATERIALS AND METHODS: Over 30 articles of recent scientific literature have been reviewed and analyzed. Studies were searched through the PubMed database using the key words: spondylo- discitis, minimally invasive, and surgical treatment. The most interesting and valid techniques and results have been reported. Despite the exclusion of case reports, all the available studies have been conducted on small groups of patients. Indications for each technique have been reported according to a clinical-radiological classification of PS. RESULTS: Six of the most widely used min- imally invasive surgical techniques have been described. High success rates have been re- ported in terms of preventing the progression of spondylodiscitis into more destructive forms, reduction of time and operative hospitaliza- tion, faster pain relief, early mobilization, and achievement of microbiological diagnosis. CONCLUSIONS: The role of minimally inva- sive surgery in the treatment of PS is rapidly ex- panding. Reducing surgery-related morbidity in these frail patients is possible and often neces- sary. However, while more and more new tech- niques are being proposed, still few clinical data are available. Clinical comparison studies with open traditional surgery should be encouraged, and more attention should be paid to long-term outcomes. For the present, the indications for minimally invasive procedures should, there- fore, be evaluated on a case by case basis and on clinical and radiological findings.