Full endoscopic discectomy, debridement, and drainage for high-risk patients with spondylodiscitis

Abstract Objective To evaluate the efficacy and clinical results of full endoscopic debridement and drainage (FEDD) for high-risk patients with spondylodiscitis. Methods A total of 14 patients who underwent FEDD at our institution between November 2015 and September 2017 were retrospectively reviewed. All patients had single-level infectious spondylodiscitis and were high-risk candidates for surgery. General condition was evaluated according to the American Society of Anesthesiologists (ASA) grading system. Charlson comorbidity index (CCI) was used for comprehensive assessment of comorbidity status. Outcomes were evaluated by numeric rating scales (NRS) pain score, Oswestry Disability Index (ODI), modified MacNab criteria, and radiographic images at follow-up. Results All the 14 patients experienced immediate relief of back pain after FEDD with no procedure-related complications. The causative bacteria were identified in 10 (71.5%) of the 14 patients. Half of the 14 patients had an ASA score of ≥3. The average CCI was 5.1±1.6 points. As compared to the preoperative NRS score of 8.2 ± 0.9, the NRS scores at 1-week and 12-month after surgery were 3.4±1.1 and 1.4±1.2, respectively. A significant improvement in ODI was observed after surgery [preoperative, 30.1±3.9; 12-month postoperatively, 17.6±6.2 (P Conclusions FEDD may be an effective alternative to extensive open surgery in patients with infections spondylodiscitis, especially those who are high-risk candidates for surgery (elderly patients with multiple comorbidities; patients with poor general condition).