The natural history of uncomplicated hematogenous pyogenic
spondylodiscitis is self-limiting healing. However, a variable degree of bone destruction frequently occurs, predisposing the spine to painful
kyphosis.
Delayed treatment may result in serious neurologic complications. Early
debridement of these
infections by percutaneous transpedicular
discectomy can accelerate the natural process of healing and prevent progression to bone destruction and
epidural abscess. The purpose of this manuscript is to present our technique of percutaneous transpedicular
discectomy (PTD), to revisit this minimally invasive surgical technique with stricter patient selection, and to exclude cases of extensive vertebral body destruction with
kyphosis and neurocompression by
epidural abscess, infected
disc herniation, and foraminal
stenosis. In a previously published report of 28 unselected patients with primary hematogenous pyogenic
spondylodiscitis, the immediate relief of
pain after PTD was 75%, and in the long-term follow-up, the success rate was 68%. Applying stricter patient selection criteria in a second series of six patients (five with primary hematogenous
spondylodiscitis and one with secondary postlaminectomy-
discectomy spondylodiscitis), all patients with primary hematogenous
spondylodiskitis (5/5) experienced immediate relief of
pain that remained sustained at 12-18 months follow-up. This procedure was not very effective, however, in the patient who suffered from postlaminectomy
infection. This lack of response was attributed to postlaminectomy-
discitis instability. The immediate success rate after surgery for unselected patients in this combined series of 34 patients was 76%. This technique can be impressively effective and the results sustained when applied in the early stages of uncomplicated
spondylodiscitis and contraindicated in the presence of instability,
kyphosis from bone destruction, and neurological deficit. The special point of this procedure is a minimally invasive technique with high diagnostic and therapeutic effectiveness.