• Pedro Gonçalo Pereira Abreu, José Artur Lourenço, Clara Romero, Gonçalo Neto D Almeida, Lia Pappamikail, Maria Fátima Lopes, Miguel Brito, Pedro Teles, and Joaquim Pedro Correia.
• Neurosurgery Department - Serviço de Neurocirurgia, Centro Hospitalar Universitário Do Algarve, Rua Leão Penedo, 8000-386, Faro, Portugal. pabreu@chalgarve.min-saude.pt.
• Eur Spine J. 2022 Jul 1; 31 (7): 1765-1774.

BackgroundSpondylodiscitis is a severe condition where standalone antibiotic therapy resolves most cases. In refractory infections, open surgery may aid with infection debulking. However, significant morbidity can occur. Nowadays, endoscopic approaches are emerging as an alternative. However, until now, only small-scale studies exist. Being so, we carried the first systematic review on spondylodiscitis endoscopic debridement indications, technique details, and outcomes.MethodsSearch for all English written original studies approaching the spondylodiscitis endoscopic treatment was performed using PubMed and EBSCO host. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a pre-specified protocol was registered at PROSPERO (CRD42020183657).ResultsFourteen studies involving 342 participants were included for analysis. Data overall quality was fair. Indications for the endoscopic approach were poorly defined. The most consensual indication was refractory infection to conservative treatment. Spinal instability or neurological deficits were common exclusion criteria. All authors described similar techniques, and despite the frequent severe co-morbidities, procedure morbidity was low. Re-interventions were common. Microorganism identification varied from 54.2 to 90.4%. Treatment failure among studies ranged from 0 to 33%. Pain, functional status, and neurological deficits had satisfactory improvement after procedures.ConclusionsThe endoscopic debridement of spondylodiscitis seems to be an effective and safe approach for refractory spondylodiscitis. A novel approach with initial endoscopic infection debulking and antibiotic therapy could improve the success of spondylodiscitis treatment.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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