Case Report: Interim success in treating pyogenic spondylitis caused by Staphylococcus epidermidis using UBE...

Background Pyogenic spondylitis is a spinal infection caused by non-specific pathogens, with pathological changes typically manifesting as purulent inflammation. The main causative agents include Staphylococcus aureus, Escherichia coli, and others. In recent years, due to factors such as surgical procedures, diabetes mellitus, immunosuppression, and advanced age, the incidence of spinal infections has risen annually-posing significant challenges in diagnosis and treatment. This case report describes the diagnostic and therapeutic experience of a patient with pyogenic spondylitis complicated by diabetes (without obvious immunodeficiency): after poor outcomes with long-term initial therapy, the patient was treated with UBE (Unilateral Biportal Endoscopy) technique. The infection was confirmed to be caused by Staphylococcus epidermidis, with remarkable outcomes observed during follow-up.Case Presentation The patient was a 74-year-old female farmer presenting with pain and weakness in both lower limbs for over 3 months. Her pain was a persistent dull ache-unrelieved by rest, progressively worsening, and scored 7 on the Numerical Rating Scale (NRS). It severely disrupted sleep, requiring opioid analgesics for relief.Based on clinical manifestations, past medical history, laboratory tests, and imaging studies, pyogenic spondylitis was suspected. The patient had undergone a long course of initial anti-infective therapy; while systemic infection was controlled, vertebral infection and intervertebral disc abscess formation compressed nerves-causing intractable lower limb pain. Surgery was thus indicated. The procedure consisted of UBE-assisted posterior lumbar spinal canal exploration and decompression, lumbar lesion resection, and spinal focus debridement. Intraoperatively, multiple tissue samples were collected for bacterial culture and identification. Results confirmed the spinal infection was caused by Staphylococcus epidermidis(S. epidermidis). Subsequently, anti-infective therapy was continued per drug sensitivity testing.At ∼6 months postoperatively, the patient has recovered well: she is afebrile, reports significant pain reduction (NRS score: 2), and shows improvements in laboratory and imaging findings. She remains under continuous follow-up.