Efficacy analysis of transforaminal endoscopic debridement combined with a custom-designed irrigation and drainage system for treating lumbar infections following unilateral biportal endoscopic spinal canal decompression

English Keywords:Lumbar intervertebral infections  Unilateral biportal endoscopic  Percutaneous transforaminal endoscopic  Custom-designed irrigation and drainage system

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical efficacy of percutaneous transforaminal endoscopic debridement combined with irrigation using a custom-designed irrigation and drainage system for the treatment of epidural fluid accumulation with lumbar intervertebral infections following unilateral biportal endoscopic(UBE) decompression surgery. Methods: A retrospective analysis was conducted on 12 cases of lumbar infections after UBE lumbar spinal canal decompression treated at Shanxi Bethune Hospital from October 2020 to April 2025. There were 5 males and 7 females, aged 74-84(79.1±3.4) years old. All the patients underwent transforaminal endoscopic debridement combined with irrigation using a custom-designed irrigation and drainage system, with targeted antibiotic perfusion therapy based on bacterial culture results. Follow-up assessments were performed at 3d, 1 month, and the final follow-up, including tests for white blood cell count, neutrophil percentage(%), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), and interleukin-6(IL-6) levels among cytokines. Additionally, visual analog scale(VAS) scores for low back pain, Oswestry disability index(ODI), and other relevant clinical scores were recorded at these intervals. Lumbar MRI was performed based on patient recovery to observe postoperative imaging changes. At final follow-up, the postoperative efficacy was evaluated according to the modified MacNab criteria. Results: All 12 cases were followed up for 6-12 months(9.3±3.1 months). The infections were successfully eradicated in all patients, with no recurrence observed and primary wound healing achieved. At the final follow-up, laboratory markers including white blood cell count, neutrophil percentage(%), ESR, CRP, and IL-6 levels had normalized. Lumbar pain VAS scores was 3.67±0.58 points at 1 month after operation, while JOA scores was 24.00±2.00 points and ODI was (27.33±4.16)%. By the final follow-up, VAS scores improved to 2.13±0.68 points, JOA scores to 25.33±1.53 points and ODI to (14.67±2.08)%. The differences from the preoperative values were statistically significant(P<0.05). At final follow-up, lumbar MRI findings of 12 patients showed significant improvement in the epidural effusion and infection from the conditions before debridement, and the outcomes were rated as excellent in 10 cases and good in 12 cases according to the modified MacNab criteria. Conclusions: Percutaneous transforaminal endoscopic debridement combined with irrigation via a custom-designed irrigation and drainage system technique is a feasible, safe, and effective treatment for lumbar infections following UBE decompression surgery.