Endoscopic Treatment of Thoracolumbar Spondylodiscitis: A Systematic Review and Meta-Analysis

Background: Endoscopic surgery is a minimally invasive procedure that has been shown to relieve intradiscal pressure, irrigation of inflammatory factors, and visual debridement, which are crucial for the successful treatment of spondylodiscitis. This study proposes a systematic review and meta-analysis to evaluate the effectiveness and safety of endoscopic treatment of thoracolumbar spondylodiscitis. Methods: Multiple databases were searched for studies involving thoracolumbar spondylodiscitis treated by endoscopic disc drainage with or without additional posterior fixation over the last 20 years. Studies that met the inclusion criteria, which included outcomes related to the percentage of cured infections, patient satisfaction, regression of inflammatory markers, and/or the percentage of adverse event rates, were included in the analysis. For each study, the percentage of patients who showed improvement or experienced an adverse event was abstracted and pooled in a meta-analysis. Results: Based on the search strategy and inclusion criteria, our systematic review and meta-analysis included 20 studies with 546 participants. The success rate was 89.4% (95% CI 83.1%–94.5%). The rate of major adverse events was 0.3%, while that of postoperative transient paresthesia was 2.6% (95% CI 0.8%–5.1%). The recurrence rate was 1.7% (95% CI 0.3%–4.0%), and revision surgery was 8.5% (95% CI 3.8%–14.6%). The causative pathogen diagnosis rate was 73.9% (95% CI 67.7%–79.8%), while progression of deformity was 3.7% (95% CI 0.2%–9.8%), and spontaneous fusion was 40.1% (95% CI 11.0%–73.3%). Conclusions: Endoscopic discectomy for thoracolumbar spondylodiscitis has been shown to be a safe technique with satisfactory clinical outcomes and a high causative pathogen identification rate.