Full-Endoscopic Spine Surgery Enables High Rates of Pathogen Identification after Short-Term Antibiotic Therapy in...

Prompt and accurate identification of pathogens is essential for effective treatment of pyogenic spondylitis. However, conventional non-surgical methods, such as blood culture and percutaneous needle biopsy, have limited sensitivity and reliability. This multicenter study investigated whether specimen collection during full-endoscopic spine surgery (FESS) is more useful than the conventional diagnostic modalities.

We retrospectively analyzed data for 53 patients diagnosed with pyogenic spondylitis across three participating institutions between January 2021 and April 2025. Pathogen identification rates were compared between FESS, percutaneous needle biopsy, and blood culture. The patients were stratified into three groups based on duration of pre-procedural antibiotic therapy (0 days, 1-13 days, or ≥14 days) to determine the influence of antibiotic exposure on diagnostic yield. Multivariate analysis was performed to adjust for inflammatory markers and clinical factors.

The overall pathogen identification rate was 79.2%, with Escherichia coli (20.8%) and Staphylococcus aureus (17.0%) being the most frequent isolates. FESS achieved the highest identification rate (59.2%), followed by needle biopsy (45.2%) and blood culture (38.6%). Although detection rates were similar among the three methods in antibiotic-naïve patients, FESS demonstrated a significantly higher detection rate in the 1-13-day antibiotic group than blood culture (87.5% vs 16.7%, p=0.026), whereas the difference between FESS and needle biopsy (57.1%) was not statistically significant. FESS yielded positive results in 15.6% of patients, identifying pathogens despite negative findings on both blood culture and needle biopsy.

FESS enables direct targeted sampling of infected tissues, resulting in pathogen identification rates that are higher than those with conventional diagnostic methods, particularly in patients with short-term antibiotic exposure. Unlike needle biopsy, FESS allows for the retrieval of adequate samples under direct vision. These findings indicate that FESS is a valuable diagnostic tool that complements its therapeutic role, potentially facilitating earlier optimization of antimicrobial therapy.