Endoscopic Treatment of Thoracic Discitis with Robotic Access: A Case Report Merging Two Cutting-Edge Technologies

Emerging technologies in minimally invasive spinal surgery include surgical robots for navigation and spinal endoscopy. We applied these technologies in concert to treat a critically ill patient with thoracic discitis.

The patient was an 83-year old woman with extensive medical comorbidities. In 2016, she was admitted from her skilled nursing facility with chest pain radiating to her left arm. Following a negative cardiac workup, computed tomography imaging revealed a right paramediastinal thoracic collection with endplate erosion at the T4 and T5 levels. Subsequent magnetic resonance imaging was consistent with spondylodiscitis. We developed a preoperative trajectory with targeting software to the target levels. Following positioning and calibration in the operating room, we used the robot to establish our planned trajectory along the T4-T5 transpedicular route on the left side. We established a working channel and docked the endoscope through the T4-T5 annulus. Frank pus extruded on entering the disc, which we immediately sampled and sent for culture. We next advanced the endoscope into the disc space, allowing us to clean the endplates with microcurettes and copious irrigation. The patient tolerated the procedure well and was sent to the intensive care unit in light of her general medical status. She recovered well and was discharged from our hospital on postoperative day 11 after a course of intravenous antibiotics.

This case represents a novel endoscopic-robotic hybrid spine surgery that we believe will find further applications in spinal surgery.