Novel minimally invasive management of lumbar osteomyelitis: A case report

INTRODUCTION AND IMPORTANCE: Vertebral osteomyelitis is a rare disease that might lead to significant clinical problems. Initially, conservative therapy is considered to be sufficient for most patients. However, it is not uncommon that the infectious process may become fulminant and severe complications could arise. Recent studies have shown that percutaneous endoscopic debridement provides a favorable outcome in managing lumbar infections without severe neurological symptoms. CASE PRESENTATION: We presented a case report of a female, 49 years old, with pyogenic vertebral osteomyelitis of the 4th - 5th lumbar spine without neurologic deficit. X-ray examination showed a resemblance of the lytic lesion over the anterior aspect of the L4. We then planned a minimally invasive endoscopic procedure for the patient. We made the 1st portal to aspirate the abscess product and for the endoscopy instrument to debride the remaining debris material. We also developed the second portal using kyphoplasty needl towards the pedicle to gain access to the vertebral body. The debriding process was achieved by positive irrigation pressure from one portal to another using physiologic NaCl saline and gentamicin solution. CLINICAL DISCUSSION: Combined with the access created by the kyphoplasty needle, more thorough irrigation was made possible as the intravertebral body was approachable. Compared to open surgery, this approach can reduce surgical damage. Clinically, patient experienced an almost instant relief of pain. CONCLUSION: Percutaneous endoscopic debridement technique in addition of kyphoplasty needle allows wider area for adequate debridement and better result, while maintaining minimally invasive setting with minimum complications.