PERCUTANEOUS TRANSPEDICULAR MANAGEMENT OF DISCITIS

PURPOSE: To present the technique of percutaneous transpedicular biops y and debridement of discs in diagnosis and management of discitis. MA TERIALS AND METHODS: Fifteen patients underwent disc biopsy through a transpedicular approach with local anesthesia and fluoroscopic guidanc e. An attempt was made to debride the disc as much as possible. A surg ical vacuum drain was deployed through the transpedicular tract when t here was persistent drainage. RESULTS: Fifteen patients underwent perc utaneous transpedicular disc biopsy and debridement of disc for suspec ted discitis. Three patients underwent biopsy only and 12 underwent pe rcutaneous discectomy. Six patients had at least one positive culture. Eight patients who underwent discectomy had immediate improvement of pain or neurologic symptoms, obviating emergency surgical debridement of the disc. Four patients did not improve and underwent surgical debr idement and fusion. CONCLUSIONS: Transpedicular biopsy of the disc is an effective technique for adequate tissue retrieval and diagnosis of discitis. Adequate debridement in selected patients with antibiotic th erapy may be definitive. Epidural extension of discitisand massive ver tebral destruction precludes percutaneous treatment.