化膿性脊椎炎に対する鏡視下椎間板ヘルニア摘出術（PED）の術後成績

The number of pyogenic spinal infections has been increasing in the past few decades. The main reason for increasing of cases is increasing of immunosuppressed patients, such as diabetes mellitus, neoplasmic disease, collagen disease or chronic renal failure. Some immunosuppressed patients with pyogenic spinal infection were resistant to an antibiotic treatment and they were not able to undergo major spinal surgery due to their poor general conditions. Percutaneous endoscopic lumbar discectomy（PED）is performed under local anesthesia and requires an８mm skin incision. PED is the least invasive disc surgery procedure, especially for poor general condition patients with pyogenic lumbar spondylitis. The purpose of this study is to evaluate effect of PED procedure for pyogenic spondylitis. Four male and one female pyogenic spondylitis underwent PED surgery under local anesthesia. The mean age was６７．０±12.9（４７－７７）. The number of complications for ４ patients is as follows；２malignant tumor,３hypertension,１diabetes mellitus,１liver cirrhosis and １ Parkinson disease. Causative bacteria were identified in the blood or the biopsy specimens. We performed the debridement of the infected disc and of the partial endplate in the lumbar spine. Approximately３０００－ ５０００milliliter saline was used for irrigation. The mean day from diagnosis to surgery was １２．６ days（１１－１５ days）. Post operative courses of all patients were successful. The mean day to turn CRP negative after surgery is５２．２ days（３８－１１０ days）. There was no complication and no additional surgery after debridement using PED procedure. The PED procedure is superior to other treatments in terms of directly debridement and lavage the infected sites. The most advantage of PED procedure is able to directly observe on clear vision under endoscope. Moreover, PED surgery can be safely performed under local anesthesia and requires the least invasion. This procedure can be applied to the poor general condition’s patients.