Comparison of Ct-guided Needle Biopsy versus Percutaneous Endoscopic Debridement and Drainage in Pathogen Identification and Pain Outcomes for Spondylodiscitis Patients: A Systematic Review

Introduction: Spondylodiscitis (SD) is an infection of the intervertebral disc with involvement of the adjacent vertebral bodies. Treatment requires targeted antibiotic administration following pathogen identification. However, positive yield from blood cultures is limited, ranging from 46% to 67%. Subsequent diagnostic tests with CT-guided biopsy only provide a positive yield in 14% to 48% of cases. These challenges delay diagnosis by approximately two to six months contributing to a worse prognosis and increasing morbidity.

Methods: We conducted a broad systematic review of the literature using PRISMA guides to compare differences in pathogen identification for percutaneous endoscopic debridement and drainage (PEDD) versus CT-guided needle biopsy in SD patients. Secondary outcomes evaluated were clinical presentation, site of intervention, and pain reduction. Of the 1078 studies returned, 87 studies underwent full review. We applied the following inclusion criteria: 1) positive pathogen identification percentage following intervention with reported pathogen species. In addition, the following exclusion criteria were used: 1) nonspecific demographic criteria; 2) inclusion of repeat procedures. Ultimately, a total of 15 studies were included (7 PEDD, 7 CT, 1 CT vs. PEDD). All studies were Oxford Centre for Evidence-Based Medicine Level 3.

Results: We found 162/192 (84.38%) patients who underwent PEDD received positive microbiology results, compared to 221/604 (36.59%) CT-guided biopsy patients. Two PEDD studies reported greater than 50% reduction in average pain scores postoperatively. In the remaining five PEDD studies that reported pain outcomes, greater than 80% of patients experienced relief after intervention. Only one study on CT-guided biopsy reported data on pain, in which 0/32 patients experienced relief.

Conclusion : These results suggest that PEDD may improve pathogen identification while simultaneously reducing pain compared to CT-guided needle biopsy in SD. Further clinical studies are necessary to elaborate on these findings, but these preliminary data suggest that the treatment algorithm for SD may need to be changed.