Endoscopic Decompression Can Be Effective for Diagnosing and Treating Tubercular Spondylodiskitis with Early Epidural Spinal Compression: A Retrospective Study of 18 Cases

STUDY DESIGN: Retrospective study. PURPOSE: In this study, we describe an endoscopic method of effectively treating tubercular lumbar spondylodiskitis with early onset epidural spinal cord compression in the lumbar spine on magnetic resonance imaging (MRI). OVERVIEW OF LITERATURE: Percutaneous aspiration and biopsy of spondylodiskitis under ultrasonography and computer tomography scan invariably provides an inadequate diagnosis. METHODS: From May 2015 to May 2017, 18 patients presented with intractable back pain and were diagnosed with tubercular spondylodiskitis on MRI; these patients were enrolled in this study. The goal was to confirm the pathogen on biopsy, drain the abscess, and perform debridement. Chemotherapy was started after histologic diagnosis, and data collected included blood cell counts, erythrocyte sedimentation rate, C-reactive protein, and repeat MRI after 3 months. RESULTS: Mean duration of surgery was 52 minutes. Mean follow-up was 17 months. The average preoperative Visual Analog Scale score of 8 (range, 6–10) decreased to 3 (range, 1–8) postoperatively. Tubercular spondylodiskitis was observed in 14 cases; two cases were pyogenic, and the biopsy was inconclusive in two cases. After adequate chemotherapy, no recurrences were noted. CONCLUSIONS: We hereby conclude that endoscopic biopsy and drainage can provide a better diagnosis and decrease pain in a predictable manner.