Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.
Introduction: To determine the consequences and potential mechanisms of injury to the multifidus muscle associated with surgery using the conventional thoracolumbar posterior approach. Methods: Patients were categorized into three groups based on the duration of time since their initial thoracolumbar fracture surgery: a 1-year postoperative group, a 2-year postoperative group, and a 3-year postoperative group. All patients required removal of internal fixation between May 2023 and June 2024. For each group, we performed morphometric analysis of the multifidus muscle using digital images, and muscle samples were subjected to histological analysis. Results: Digital photography indicated a significant temporal reduction in the proportion of muscle within the multifidus muscle, exhibiting a significant change over time (p<0.0001). Hematoxylin and eosin staining of histological samples revealed varying degrees of steatosis in the postoperative multifidus muscles; prolonged intervals following internal fixation surgery were associated with more pronounced fat infiltration. Analysis of the multifidus fibrosis using Masson's staining demonstrated that muscle fibers subjected to paravertebral muscle dissection surgery exhibited a tendency towards fibrosis, which increased over time. Reduced vessel density, defined by CD31 expression, was observed at all follow-up times, and the number of nerve fibers decreased significantly with increasing time post-surgery. Conclusions: Over time, the multifidus muscle exhibited obvious fibrosis and steatosis following traditional posterior thoracolumbar surgery. Our analyses suggest that the mechanism involved could be related to reduced angiogenesis and denervation.
Introduction: Adult spinal deformity (ASD) surgery is highly invasive and carries a substantial risk of postoperative wound complications, particularly in patients with type 2 diabetes mellitus (DM). Perioperative hyperglycemia is a known risk factor for surgical-site infection, but glucose thresholds specific to patients with diabetes and ASD remain unclear. Methods: We retrospectively reviewed 437 adults who underwent ASD correction between 2010 and 2020, of whom 50 (11.4%) had type 2 DM. Capillary blood glucose was measured at standardized intervals from the day of surgery through postoperative day 3 and at least once daily thereafter until discharge. For each diabetic patient, we calculated an overall mean perioperative glucose value (mean of all in-hospital measurements from postoperative day 0 to discharge) and maximum/mean glucose during postoperative days 0-3. These patient-level indices were compared between patients with and without wound complications, and receiver operating characteristic (ROC) analysis based on overall mean glucose was used to explore thresholds associated with wound morbidity. Results: Wound complications occurred more often in patients with DM than those without DM (18.0% vs 3.1%, p<0.001). Among the patients with diabetes, overall mean perioperative glucose was higher in the wound-complication group than in the non-wound group (184.8±35.1 vs 156.1±26.6 mg/dL; p=0.020). ROC analysis of overall mean glucose yielded an area under the curve of 0.75 and suggested an exploratory threshold around 185 mg/dL. Patients with diabetes also had higher rates of systemic complications. Conclusions: Type 2 DM was associated with substantially increased wound morbidity and systemic complications after ASD surgery. Higher overall mean perioperative glucose in patients with diabetes was linked to wound complications, and an exploratory threshold near 185 mg/dL showed moderate discriminatory ability. These findings support the concept that tighter perioperative glycemic control may reduce wound morbidity, although the proposed threshold should be regarded as hypothesis-generating and should be confirmed in larger prospective studies.
