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Updated: Sep 26, 2025
Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
Minimally invasive spine surgery as treatment for persistent infectious lumbar spondylodiscitis: a systematic review
Joshua Slowinski1, Christopher Lucasti1, Mark Maraschiello1
1Department of Orthopaedics, Jacob School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA.
Background:
Antibiotic resistant infectious spondylodiscitis (IS) can cause significant morbidity for patients. Open surgical techniques were previously the only option for patients who failed antibiotic therapy. However, advances in minimally invasive surgical techniques may provide a new alternative for some patients.
Methods:
A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify studies that reported inflammatory [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] and functional outcomes [visual analog scale (VAS)] for patients with antibiotic resistant IS treated with either minimally invasive or open surgery. Searches were preformed using PubMed, Embase, and Scopus from January 2015 to June 2021. Fourteen articles met inclusion criteria. One study was a Level III evidence study and the other 13 included studies were Level IV.
Results:
The minimally invasive surgery group showed significantly lower post-operative CRP and VAS pain scores and significantly higher post-operative ESR levels than the open group. All studies included were measured by the Downs and Black tool for potential bias.
Discussion:
This study showed that minimally invasive surgery is efficacious in the treatment of antibiotic resistant IS. These outcomes support minimally invasive surgery (MIS) as an effective alternative to previous open surgery techniques in certain patients after failed trails of antibiotic therapy.
Insights
Minimally invasive surgery (MIS) effectively treats antibiotic-resistant infectious spondylodiscitis (IS) when antibiotics fail. MIS offers better outcomes than open surgery for patients with this challenging spinal infection.
Area of Science:
- Spinal surgery
- Infectious diseases
- Orthopedics
Background:
- Antibiotic-resistant infectious spondylodiscitis (IS) presents significant patient morbidity.
- Historically, open surgery was the primary treatment for refractory IS.
- Minimally invasive surgical (MIS) techniques are emerging as a viable alternative.
Purpose of the Study:
- To systematically review and compare outcomes of MIS versus open surgery for antibiotic-resistant IS.
- To evaluate inflammatory markers (ESR, CRP) and functional outcomes (VAS) in treated patients.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched PubMed, Embase, and Scopus (Jan 2015-June 2021).
- Included 14 studies (1 Level III, 13 Level IV), assessing bias with the Downs and Black tool.
Main Results:
- MIS group demonstrated significantly lower post-operative C-reactive protein (CRP) and visual analog scale (VAS) pain scores.
- The MIS group exhibited significantly higher post-operative erythrocyte sedimentation rate (ESR) levels compared to the open surgery group.
- Bias was assessed across all included studies.
Conclusions:
- Minimally invasive surgery (MIS) is an effective treatment for antibiotic-resistant infectious spondylodiscitis (IS).
- MIS presents a promising alternative to open surgery for select patients with IS who have failed antibiotic therapy.
