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Use of Percutaneous Discectomy Device for Biopsy and Decompression of Infected Intervertebral Disc 2007

Interventional Spine

Serge Menkin, MD

Scientific Poster

Exhibit Panels: 1

Purpose

To show that a percutaneous discectomy device yields additional diagnostic and therapeutic value in the suspected infected intervertebral disc with equivocal magnetic resonance findings.

Methods & Materials

A 19 year-old male with progressive severe low back pain and right leg pain which came 9 days after successful lumbar discectomy. The patient was rendered non-ambulatory by the pain. An MRI with Gadolinium contrast at 18 days post-op revealed enhancement of the soft tissue mass in the L4-5 intervertebral space. The soft tissue mass created mild central stenosis and produced mass effect on the right L5 nerve root. However, the summary of the report related everything to post-surgical changes. The laboratory workup revealed leukocytosis, elevated ESR and CRP. At 4 weeks post-op, an aspiration biopsy of the L4-5 intervertebral space was performed utilizing a percutaneous discectomy device (Dekompressor; Stryker, Kalamazoo, MI).

Results

The aspiration yielded 2 cc of liquefied, necrotic disc material. This biopsy was positive for multi-drug resistant Staphylococcus Epidermidis. The patient was started on intravenous Vancomycin. In 24 hours, after the disc biopsy, the patient reported complete resolution of the leg pain and significant improvement of low back pain. He was able to ambulate for the first time in 2 weeks.

Conclusion

The percutaneous discectomy device can be used to provide further diagnostic data by tissue biopsy and culture of the suspected disc infection. The technique also allows for debridement of avascular necrotic disc tissue and rapid resolution of symptoms associated with local mass effect. An additional benefit in the treatment of the disc space infection may be an intradiscal injection of antibiotics.

References

Fantauzzi JP, Ortiz AO. Use of Percutaneous Discectomy Device for Aspiration and Drainage of Infected Intervertebral Discs. Presented at 2006 ASSR Meeting.

Slipman CW, Menkin S, Garvan C, Bender F. Percutaneous Lumbar Disc Decompression Using the Dekompressor: Preliminary Results. Presented at 22nd Annual AAPM meeting.