Rupeng Chu,1– 3 Wei Cui,1– 3 Wenjin Chen,1– 3 Yin Zhuang,1– 3 Guoyong Yin,4,5 Wei Peng,1– 3 Shujun Zhang1– 3 

1Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214063, People’s Republic of China; 2Wuxi Orthopedic Institute, Wuxi, Jiangsu, 214063, People’s Republic of China; 3Minimally Invasive Orthopedic Institute of Soochow University, Wuxi, Jiangsu, 214063, People’s Republic of China; 4Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China; 5Jiangsu Institute of Functional Reconstruction and Rehabilitation, Jiangsu Provincial Clinical Research Institute, Nanjing, Jiangsu, 210029, People’s Republic of China

Correspondence: Wei Peng, Email pengweikevin@hotmail.com Shujun Zhang, Email spine_zhang@vip.163.com

Background: Clinical management of lumbar infectious spondylodiscitis is challenging due to its variable presentation and complex course, and its treatment remains controversial. This study aims to evaluate the clinical efficacy of unilateral biportal endoscopic (UBE) debridement and drainage for treating lumbar infectious spondylodiscitis.
Methods: We retrospectively analysed sixteen patients diagnosed with lumbar infectious spondylodiscitis who underwent UBE debridement and drainage between April 2022 and July 2023. Biopsy specimens were sent to the laboratory to identify pathogens immediately after surgeries. Clinical outcomes were assessed by the visual analog scale (VAS) scores of the back, Oswestry Disability Index (ODI), the modified MacNab criteria (MNC), and regular serological tests at pre- and post-operation.
Results: Fourteen patients (87.5%) experienced a significant improvement in their clinical symptoms. Their VAS and ODI scores significantly improved compared to those before the operation throughout the follow-up (p< 0.05). The modified MNC at the last follow-up indicated that 87.50% of these participants were rated excellent or good. Causative bacteria were identified in 13 (81.25%) of 16 biopsy specimens. At the final follow-up, all patients’ kyphotic angle changes were less than 10° without spinal instability. A 12-month follow-up CT scan revealed bony intervertebral fusion in 10 cases (62.5%). The postoperative regular serological tests were significantly improved than before surgery (p< 0.05). No recurrent infections or significant surgery-related complications were observed during postoperative follow-up.
Conclusion: UBE surgery was successful in debridement, back pain relief, and bacteriologic diagnosis of lumbar infectious spondylodiscitis. This procedure could be an effective alternative for patients when conservative treatments fail.

Keywords: lumbar infectious spondylitis, unilateral biportal endoscopy, UBE, negative pressure drainage, endoscopic debridement, minimally invasive surgery