Identifying offending pathogens is crucial for appropriate antibiotic administration for infectious spondylitis. Although
computed tomography (CT)-guided biopsy for bacteriologic diagnosis is a standard procedure, it has a variable success rate.
Some reports claim percutaneous endoscopic discectomy and drainage offer a sufficient amount of tissue for microbiologic examination
and easy application. We therefore compared the diagnostic value of CT guidance with that of endoscope guidance in 52 patients
with suspected infectious spondylitis. Twenty patients underwent percutaneous endoscopic discectomy and drainage by an orthopaedic
surgeon and the other 32 patients underwent CT-guided biopsies by a radiologist. Patients were followed a minimum of 12 months
after treatment. Culture results of the biopsy specimens were recorded. Causative bacteria were identified more frequently
with percutaneous endoscopy than in CT-guided biopsy (18 of 20 [90%] versus 15 of 32 [47%]). We observed no biopsy-related
complications or side effects in either group. The data suggest percutaneous endoscopic discectomy and drainage yield higher
bacterial recovery rates than CT-guided spinal biopsy.
Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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