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Assessment of the utility of a percutaneous discectomy device in the diagnosis of spondylodiscitis. 2012

Interventional Spine

Mesha, L, Martinez, MD
Uday, Kanamalla, MD, Non ASSR Member

Paper/Non-Mentor

Purpose

To assess the utility of the percutaneous discectomy device in the diagnosis of spondylodiscitis.

Methods & Materials

A retrospective review was performed of 30 cases in which a percutaneous discectomy device (The Dekompressor®, Stryker, Inc., Kalamazoo, Michigan) was used to diagnose spondylodiscitis in patients with clinical symptoms and radiographic findings indicative of this disease. All cases were from a single institution and performed by a single operator between July 2005 and October 2011. Standard procedure for an image guided percutaneous spinal biopsy was followed, however a discectomy device instead of an aspiration needle was used to procure disc material. Patients who had negative biopsies underwent further investigation to determine if a false negative was obtained through review of their medical records dated after the biopsy. True negative (no reported spinal infection 1 year after biopsy) and positive biopsies were considered successful. A comprehensive review of the literature was then performed to compare success rates of standard percutaneous disc biopsy versus percutaneous discectomy biopsy in the diagnosis of spondylodiscitis.

Results

The study included 11 females and 19 males with an age range of 27-78 years old (average age 55). Of the 30 cases that underwent percutaneous biopsy with the discectomy device, 43% (13) were positive yielding an organism and 50% (15) were negative. 2 patients had no pathology or culture results in the system although discectomy biopsy was performed. Of those patients who had negative biopsy results, 5 of the 15 patients had no documentation of spinal infection 1 year or more post biopsy. Six of the 15 patients with negative biopsies were lost to follow up. Four of the 15 patients with negative biopsies completed 6 to 8 weeks of antibiotic therapy in spite of a negative biopsy result. Total success rate was (18 of 22) 82%.

Conclusion

Literature demonstrates that the total success rate for open and closed spinal biopsies to diagnose spondylodiscitis is 43% to 78% (1,2). Given the importance of diagnosis in patients suspected to have spondylodiscitis combined with the knowledge of low success rates and need for multiple biopsies, the idea of using a discectomy device as an alternative to percutaneous needle biopsies was introduced (3).

References/Financial Disclosures

References: (1) Gouliouris T,Aliyu SH, Brown NM. (2010) Spondylodiscits: update on diagnosis and management. J Antimicrob Chemother. 65:11-24 (2) Chew FS, Kline MG. (2001) Diagnostic yeid of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious disckits. Radiology. 218:211-4 (3) Wattamar AA, Ortiz AO. (2010) Use of a percutaneous discectomy device to facilitate the diagnosis of infectious spondylitis. Am J Neuroradio. 31:1157-1158