Efficacy of Minimally Invasive Endoscopic Debridement combined with Normal Saline Single-tube Flushing Device on Single Segment Adults Primary Pyogenic Spondylitis

Efficacy of Minimally Invasive Endoscopic Debridement combined with Normal Saline Single-tube Flushing Device on Single Segment Adults Primary Pyogenic Spondylitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy of Minimally Invasive Endoscopic Debridement combined with Normal Saline Single-tube Flushing Device on Single Segment Adults Primary Pyogenic Spondylitis Sen Liu, Chun-Ping Yin, Yu-Jie Jin, Chao-Hua Zhu, Yong-Gang Peng, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6241872/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To assess the efficacy of minimally invasive endoscopic debridement combined with normal saline single-tube flushing compared to traditional dual-tube flushing for treating single-segment primary pyogenic spondylitis in adults. Methods A retrospective analysis was conducted on clinical data from 21 adult patients with single-segment primary pyogenic spondylitis admitted between January 2016 and January 2022. The cohort included 9 males and 12 females, with a mean age of 48 years. All patients underwent minimally invasive endoscopic debridement combined with normal saline single-tube flushing. Data on surgical details, hospital stay duration, hospital expenses, infection indicators, and treatment outcomes—including Visual Analog Scale (VAS) scores for pain, Japanese Orthopaedic Association (JOA) scores and improvement rates, and Oswestry Disability Index (ODI) for functional status—were collected and analyzed over a minimum follow-up period of one year. Results All 21 patients completed follow-up, with no recurrence of lumbar disc space infection. Bacterial cultures and second-generation sequencing results were negative for all patients. The mean duration of continuous irrigation was 6.29 days, and the average time to mobilization was 3.33 days. Neutrophil percentage, C-reactive protein levels, and erythrocyte sedimentation rates were significantly lower three days and one week postoperatively compared to preoperative levels (P < 0.05). These indicators continued to decline and returned to baseline levels within one month postoperatively. VAS and ODI scores showed significant improvement at one week, one month, three months, and the final follow-up compared to preoperative levels (P < 0.01), with consistent improvement over time. Similarly, JOA scores increased significantly at the same postoperative intervals (P < 0.01), with an improvement rate of 86.05% at the final follow-up. Conclusion Minimally invasive endoscopic debridement combined with normal saline single-tube flushing is an effective approach for managing culture-negative primary pyogenic spondylitis. This technique demonstrates significant improvements in clinical outcomes and infection control, as evidenced by the comprehensive analysis of patient data. Level of Evidence Level 3 Trial registration Retrospectively registered Minimally Invasive Endoscopic Debridement Single-tube Flushing Pyogenic Spondylitis Figures Figure 1 Figure 2 Figure 3 Introduction Spinal infection refers to the infection of the spine, intervertebral discs, and surrounding soft tissues caused by specific pathogenic microorganisms [ 1 ]. Based on the site of infection, it can be classified into vertebral body, intervertebral space, epidural space, paravertebral, and intraspinal infections [ 2 ]. In recent years, there has been an increase in the incidence of non-specific infections [ 3 ]. Risk factors for spinal infections fall into two main categories. The first is compromised immune function, with diabetes being significantly associated with higher mortality rates [ 4 , 5 ]. The second involves invasive procedures, such as needle puncture therapy, open surgery, and other interventions, which can lead to postoperative infections [ 6 – 8 ]. The overall incidence of pyogenic discitis ranges from 2.2 to 5.8 cases per 100,000 people annually, with culture-negative cases occurring at a rate of 0.3 to 1.8 cases and Staphylococcus aureus -related cases at 1.6 to 2.5 cases per 100,000 people per year [ 9 ]. Typical clinical symptoms of spinal infections include severe back pain, night pain, rest pain, and fever, with or without sciatica. Early radiographic findings often reveal pathological fractures, intervertebral disc space collapse, and, in some cases, vertebral endplate erosion or kyphosis [ 10 ]. Diagnostic methods typically involve joint aspiration for synovial fluid analysis, blood cultures, and imaging studies such as X-rays or MRI. Treatment primarily involves aggressive antibiotic therapy, often administered intravenously, and may include surgical intervention to drain the infected joint. Rehabilitation and physical therapy are crucial for recovery and restoring joint function. Preventive strategies include managing underlying conditions such as diabetes or immunodeficiency disorders to reduce susceptibility to infections. Although antibiotic therapy is a cornerstone of treatment, early surgical intervention has been shown to significantly reduce mortality, recurrence rates, and hospital stays. The mortality rate for spinal infections can reach as high as 20%, underscoring the urgency of identifying the most effective treatment strategies. Compared to conservative management, early surgical intervention reduces recurrence or failure rates and mortality by 40% and 39%, respectively, while shortening hospital stays by an average of 7.75 days per patient [ 11 ]. Previous surgical treatments for lumbar disc infections have included incision, debridement, irrigation, and drainage combined with internal fixation, as well as puncture, minimally invasive surgery, open surgery, lesion removal, intervertebral grafting, and fusion. While these approaches have demonstrated satisfactory clinical outcomes [ 6 , 12 ], they also have notable drawbacks, such as prolonged operation times, significant trauma, and slow postoperative recovery. Additionally, some patients with compromised health conditions are unable to tolerate incision, debridement, and drainage procedures [ 13 ]. The percutaneous foraminal endoscopic technique, characterized by its simplicity, safety, and minimally invasive nature, has been increasingly utilized not only for treating lumbar disc herniation but also for managing lumbar space infections [ 14 ]. This technique offers a promising alternative, particularly for patients with poor health who cannot endure more invasive procedures. It has shown potential in reducing operation times, minimizing tissue damage, and accelerating postoperative recovery. Furthermore, its versatility has expanded its application to various spinal conditions, broadening the scope of minimally invasive spinal surgery. Preliminary studies have reported high patient satisfaction and improved clinical outcomes, reinforcing its efficacy and safety. As research progresses, this technique is expected to further refine treatment protocols and emerge as a standard approach for managing lumbar space infections and other spinal pathologies. In recent years, percutaneous endoscopic debridement combined with external drainage has been validated as an effective treatment for lumbar disc infections. However, despite its growing adoption, traditional irrigation and drainage methods often rely on individual incisions and tubing, which can increase tissue trauma and the risk of infection [ 15 ]. Additionally, mid-term efficacy studies on endoscopic treatment of lumbar disc infections remain limited. This study aims to evaluate the efficacy of minimally invasive endoscopic debridement combined with an original incision normal saline single-tube flushing device for treating single-segment primary pyogenic spondylitis in adults. Through a retrospective analysis, the findings seek to provide valuable insights for clinical practitioners and contribute to the advancement of surgical management strategies for this complex condition. Methods Study Design This retrospective study analyzed clinical data from 21 adult patients with single-segment primary pyogenic spondylitis who were admitted between January 2016 and January 2022. The primary objective was to evaluate the efficacy of minimally invasive endoscopic debridement combined with a normal saline single-tube flushing device for managing this condition. Participants The study included 21 adult patients diagnosed with single-segment primary pyogenic spondylitis, comprising 9 males and 12 females, with a mean age of 52 years. All patients underwent minimally invasive endoscopic debridement combined with normal saline single-tube flushing. Data Collection Preoperative data, including patient demographics and basic surgical information, were collected and analyzed. Postoperative parameters such as the duration of continuous irrigation, time to mobilization, length of hospital stay, infection indicators, hospital expenses, pain scores, and functional status were monitored at various postoperative intervals. Infection indicators included white blood cell count, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, interleukin-6, procalcitonin, blood culture, bacterial culture of lesion tissues obtained during surgery, pathological examination, Brucella tube agglutination test, T-spot test, tissue pathology TB-DNA positivity, X-pert, and metagenomic next-generation sequencing (mNGS). These indicators were monitored at multiple time points within three months postoperatively. Outcome Measures The overall treatment efficacy was assessed using Visual Analog Scale (VAS) scores for pain, Japanese Orthopaedic Association (JOA) scores and improvement rates, and Oswestry Disability Index (ODI) scores for functional status. Data were collected for a minimum follow-up period of one year for all patients. Surgical Procedure Percutaneous endoscopic debridement and drainage (PEDD) were performed using the Yeung Endoscopic Spinal System (Richard Wolf GmbH, Knittlingen, Germany) via a posterolateral percutaneous approach. Sedation was administered by anesthesiologists locally, with the patient remaining awake. All patients were placed in the prone position. Under intraoperative fluoroscopy guidance, a needle was initially inserted into the infected region, and the abscess was aspirated and sent for culture. Next, a guidewire was introduced into the intervertebral disc space, and the needle was removed. A small skin incision (approximately 0.5 to 1 cm) was made, followed by the insertion of dilators and working cannulas. The guidewires were sequentially advanced into the disc spaces. Once the cannula position was confirmed, its tip was observed penetrating the tissue under fluoroscopy, and biopsy samples were collected. Nucleotomy forceps were inserted through the dilators to extract additional tissue. The intervertebral disc infection was monitored using fluorescence. Necrotic intervertebral disc tissue and any areas of endplate destruction in the adjacent vertebral bodies were removed as extensively as possible. Finally, a single flushing tube (5 mm in diameter), including two inflow tubes and a drainage tube, was inserted through the skin incision into the debrided disc space and connected to a negative pressure pump. Postoperative Care Postoperatively, for 1 to 5 days, intravenous diuretics in small doses were administered to alleviate muscle, soft tissue, and nerve damage caused by traction, peeling, and edema during surgery. Oral muscle relaxants, analgesics, gastric protectants, and neurotrophic drugs were prescribed to promote recovery. The surgical incision and drainage were closely monitored, with dressing changes performed 1 to 2 times daily. The drainage tube was flushed continuously with physiological saline (0.9% sodium chloride) at a flow rate of 40 to 60 drops per minute for 1 week, or until the drainage fluid became clear for three consecutive days. While bedridden, patients were instructed to exercise their lung function by blowing a balloon and to elevate and move their lower limbs to prevent deep vein thrombosis. After the drainage tube was removed, patients were instructed to wear a waistband for support during ground activity. Sensitive antibiotics were administered for 12 weeks based on drug sensitivity results. In cases where pathogens were not detected in the biopsy cultures of infected tissue, empiric antibiotics were used. After discharge, patients were instructed to keep the surgical incision dry and change the dressing 2 to 3 times daily. Stitches were removed 14 days after surgery, and patients with osteoporosis were advised to start anti-osteoporosis treatment. For at least 3 months post-discharge, patients were instructed to wear a waistband while getting out of bed and moving around. Regular monitoring of infection indicators, including white blood cells, C-reactive protein, and erythrocyte sedimentation rate, was recommended. Additionally, postoperative re-examinations, including lumbar spine X-rays, MRI, and CT scans, were performed to assess the lesions and spinal stability. Normal Saline Single-tube Flushing Device A single-tube flushing device was used to treat early incision infections following lumbar spine surgery (Fig. 1 ). The device consists of two flushing catheters and a drainage catheter, all wrapped within a single main tube with a diameter of 5.5 millimeters. The flushing and drainage tubes are connected at their ends to a physiological saline infusion set and a negative pressure suction device, respectively. The tail end of the flushing catheter is connected to the flushing liquid bottle, while the tail end of the drainage catheter is linked to the top of the negative pressure suction ball. This single-tube flushing device requires only one tube and channel to achieve sufficient flushing and drainage of the deep wound surface, effectively controlling infection without the need for a double-tube, double-channel system. Its advantages include a simple structure, rational design, and low manufacturing cost. Radiological Assessment MRI appearances were classified according to the following criteria [ 16 – 19 ] as follows: Type I: MRI shows mild abnormal signals in the vertebral endplate region and adjacent bone marrow, with corresponding intervertebral discs showing either normal or degenerative changes consistent with adjacent discs. Type II: MRI findings include narrowing of the intervertebral space, collapse, and fragmentation of the intervertebral disc, with T2-weighted imaging (T2WI) showing significantly high signal intensity. Type III: Varying degrees of vertebral body and intervertebral disc destruction with abnormal signals. Type IV: Soft tissue swelling around the small joints with unclear boundaries, possible abscess formation, and erosive destruction visible in adjacent bone tissue. Statistical Analysis Statistical analyses were conducted using paired t-tests and independent samples t-tests. Independent samples t-tests were used to compare measurement data between two groups, while paired samples t-tests were used to compare preoperative and postoperative measurement data. Chi-square tests were applied to analyze count data. A p-value of < 0.05 was considered statistically significant. All statistical analyses were performed using SPSS software version 23.0 (SPSS Inc., Chicago, Illinois). Results All 21 patients were followed up, and no recurrence of lumbar disc space infection was observed. Microbiological culture results revealed that 16 cases were confirmed as bacterial culture-positive pyogenic spondylitis, while 5 cases were culture-negative pyogenic spondylitis. The average duration of continuous irrigation was 6.29 days, and the average time to mobilize was 3.33 days (Table 1 ). Based on MRI findings, four types of infection were identified: Type I (7 cases), Type II (4 cases), Type III (6 cases), and Type IV (4 cases) (Fig. 2 ). Table 1 The Main Demographic Variables of Patients Before Surgery Items Minimum value Maximum value Mean ± SD Age (years) 37 54 47.81 ± 5.11 BMI (kg/m2 18.37 28.48 23.51 ± 2.69 Operation time (min) 50 136 97.10 ± 21.52 Incision length (mm) 0.8 1.4 0.99 ± 0.18 Blood loss (ml) 41 59 50.24 ± 4.25 Time of weight-bearing (day) 2 5 3.33 ± 0.80 Infection Indicators : Three days and one week after surgery, white blood cell count, neutrophil percentage, C-reactive protein, and erythrocyte sedimentation rate were significantly lower than preoperative levels (P < 0.05). These values continued to decrease after one month postoperatively and returned to baseline levels (Table 2 ). Table 2 Evaluation of Infection indicators Items Preoperative postoperative 3 days 7 days 1 month 3 months Blood cell count(10 9 /L) 13.22 ± 2.34 11.66 ± 2.18* 9.44 ± 1.04*# 5.87 ± 0.98*#◆ 5.90 ± 1.67*#◆ Neutrophil percentage (%) 85.15 ± 3.22 79.64 ± 1.54* 71.16 ± 3.49*# 67.15 ± 4.03*#◆ 62.87 ± 3.09*#◆◇ CRP (mg/L) 75.55 ± 11.77 71.30 ± 8.16 24.76 ± 9.00* 11.41 ± 4.39*#◆ 6.04 ± 2.39*#◆◇ ESR (mm/h) 61.25 ± 8.62 56.84 ± 7.01* 41.17 ± 9.98*# 32.20 ± 3.74*#◆ 20.25 ± 3.60*#◆◇ Note: “*” There were statistically significant differences compared to preoperative conditions. “#” Statistically significant differences were observed at 7 days postoperatively. “◆” Statistically significant differences were observed at 1 month postoperatively. “◇” Statistically significant differences were observed at 3 months postoperatively. The differences were significant at P < 0.05 level. VAS Score : At one week, one month, three months postoperatively, and at the final follow-up, the VAS scores were all significantly lower than preoperative levels (P < 0.01). A gradual decrease in scores was observed at each postoperative time point, with statistical significance (P < 0.01) (Table 3 ). Table 3 Evaluation of VAS score and Functional status Items Preoperative postoperative 7 days 1 month 3 months Final follow-up VAS 7.19 ± 0.68 3.95 ± 0.74* 3.05 ± 0.22*# 2.10 ± 0.44*#◆ 1.76 ± 0.54*#◆ ODI (%) 71.72 ± 5.04 48.94 ± 5.79* 30.98 ± 5.09*# 18.53 ± 2.90*#◆ 15.07 ± 1.43*#◆◇ JOA 8.71 ± 1.62 18.14 ± 1.46* 23.14 ± 1.80*# 25.29 ± 2.05*#◆ 26.19 ± 1.33*#◆ JOA improvement Rate (%) 46.12 ± 8.87 71.17 ± 8.85# 81.32 ± 10.54#◆ 86.07 ± 6.70#◆◇ Note: “*” There were statistically significant differences compared to preoperative conditions. “#” Statistically significant differences were observed at 7 days postoperatively. “◆” Statistically significant differences were observed at 1 month postoperatively. “◇” Statistically significant differences were observed at 3 months postoperatively. The differences were significant at P < 0.05 level. Functional Status : JOA Score At one week, one month, three months postoperatively, and at the final follow-up, the JOA scores were significantly higher than preoperative levels (P < 0.01), with a gradual increase at each time point showing statistical significance (P < 0.01). The improvement rate of the JOA score at the final follow-up was 86.05%. ODI Score At one week, one month, three months postoperatively, and at the final follow-up, the ODI scores were significantly lower than preoperative levels (P < 0.01), showing statistical significance (P < 0.01) (Table 3 and Fig. 3 ). Discussion Minimally invasive endoscopic debridement combined with a normal saline single-tube flushing device has demonstrated favorable outcomes in the treatment of culture-negative primary pyogenic spondylitis. The results of this study suggest that this combined approach can lead to improved clinical outcomes, including pain relief, enhanced functional status, and effective infection control in adult patients with single-segment primary pyogenic spondylitis. Delayed treatment of pyogenic spondylitis can result in the spread of infection, and in cases where bacterial virulence is strong and the disease progresses rapidly, it may lead to severe complications such as septicemia, septic shock, intracranial infection, respiratory failure, and high mortality rates ranging from 2–17% [ 20 ]. Regardless of the patient's hemodynamic stability, prompt microbiological diagnosis and initiation of antibiotic therapy are crucial. Empirical antibiotic therapy should be avoided until the pathogen is identified [ 21 ]. The positivity rate of microbiological testing is a key factor influencing prognosis. Appropriate antimicrobial therapy, when standardized and administered for a sufficient duration, is essential for controlling infections [ 22 ]. Traditional methods for pathogen identification include blood cultures, CT-guided biopsies, and open surgery. However, blood cultures have a low pathogen detection rate, and CT-guided biopsies face limitations in specimen collection due to restricted operative space, with a sensitivity of 30%-74% [ 23 , 24 ]. Open surgery provides the advantage of obtaining more pathological tissue for microbiological analysis, along with debridement and fixation [ 6 , 16 ]. However, it carries risks such as wound non-healing, sinus formation, implant infection, and fusion device infection [ 25 , 26 ]. In some cases, repeated debridement surgeries are required until the implant is removed to effectively control the infection. With the advancement of minimally invasive techniques, these methods can also provide sufficient pathological tissue, increase pathogen detection rates, and offer a promising alternative for treating intervertebral space infections. The treatment of vertebral pyogenic spondylodiscitis typically involves addressing the anterior part of the vertebral body, which is primarily infected and damaged. The formation of epidural abscesses or sequestrated bone at the affected site often leads to compression of the dura mater [ 27 , 28 ]. Consequently, many surgeons prefer anterior decompression for debridement of vertebral osteomyelitis followed by autologous bone grafting, with the anterior lateral approach being commonly used. However, anterior decompression surgery has several drawbacks, including prolonged postoperative bed rest, the need for auxiliary support, limitations in lumbar spine application, potential impact on lung function with thoracotomy, and risks of graft collapse or subsidence leading to kyphosis [ 29 , 30 ]. Most researchers agree that the posterior elements of the vertebrae maintain a certain degree of stability, whereas vertebral body decompression surgery may further compromise spinal stability [ 11 , 31 ]. Minimally invasive surgery, due to its natural passage, does not disrupt the vertebral plate and facet joint, thus preserving the integrity of the posterior column of the vertebrae while performing debridement and drainage of intervertebral abscesses. Fu et al. found that, compared to traditional anterior open surgery, percutaneous endoscopic surgery significantly reduces blood loss and shortens hospital stay. Additionally, the normalization rate of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) is faster [ 32 ]. Compared with traditional posterior lumbar interbody fusion (PLIF) surgery, percutaneous endoscopic lumbar discectomy (PELD) has been reported to have advantages such as shorter operation time, less intraoperative blood loss, and shorter hospital stay. Significant improvements in postoperative inflammatory markers (such as ESR and CRP levels) and neurological function (ASIA grade) were observed following PELD surgery, although the differences between the two groups were not statistically significant. Furthermore, patients in the PLIF group showed significant improvements in intervertebral space height and lumbar lordosis angle [ 33 ]. In terms of inflammation control, the results of this study indicate that percutaneous endoscopic lumbar discectomy effectively controls ESR and CRP levels, with values returning to baseline within three months. However, for patients with poor physical conditions who are suffering from infectious spondylitis, percutaneous endoscopic debridement and fusion may be a better option, as it can significantly reduce the risk of sepsis and mortality. A retrospective cohort study by Wang et al. demonstrated that percutaneous endoscopic debridement and fusion (PEIDF) can reduce the risk of sepsis and mortality in patients with infectious spondylitis who have poor physical conditions [ 34 ]. In this study, all patients underwent single-tube drainage with an original incision, utilizing a 5mm diameter tube with two inflow tubes and one drainage tube. This device was inserted into the intervertebral disc space through the skin incision, achieving favorable outcomes. Literature indicates that methods for draining purulent fluid in spinal infections include percutaneous aspiration, lesion puncture under CT guidance, and catheter drainage, all of which have shown satisfactory results for treating lumbar vertebrae infections [ 35 , 36 ]. Xu et al. reported that intraoperative CT-guided minimally invasive percutaneous debridement and lavage is an effective method for treating multilevel intervertebral discitis. This technique uses CT guidance to enter the intervertebral disc space through a percutaneous incision for debridement and lavage, contributing to therapeutic efficacy [ 37 ]. However, simple catheter irrigation and drainage may not directly remove diseased tissue, and drainage failure can occur due to the viscous nature of purulent fluid. The single-tube drainage device used in this study, compared to traditional multi-incision drainage, provides effective drainage while reducing skin trauma and lowering the risk of infection. Postoperative assessments showed notable reductions in inflammatory markers such as neutrophil percentage, C-reactive protein, and erythrocyte sedimentation rate, indicating the successful resolution of the inflammatory response. These findings highlight the therapeutic benefits of the minimally invasive approach in reducing the systemic inflammatory burden associated with pyogenic spondylitis. The results of this study support the effectiveness of minimally invasive endoscopic debridement combined with a normal saline single-tube flushing device for treating single-segment adult primary pyogenic spondylitis. Clinical improvements were observed across multiple outcome measures, including VAS scores for pain, JOA scores, and ODI for functional status, at multiple postoperative time points, including the final follow-up. These improvements suggest the potential effectiveness of the combined treatment approach. Abreu et al. conducted an analysis of 342 participants, reporting microbial identification rates ranging from 54.2–90.4%, and treatment failure rates from 0–33%. The study showed satisfactory improvements in pain, functional status, and postoperative neurological deficits [ 38 ]. A key finding in our study was the absence of lumbar disc space infection recurrence during the follow-up period, demonstrating the potential of the combined treatment approach in preventing disease relapse. This aligns with previous studies that emphasize the advantages of minimally invasive techniques in reducing postoperative complications and enhancing patient satisfaction. Lin et al. reported that among 34 patients undergoing minimally invasive endoscopic surgery for infectious spondylodiscitis, 2 patients (3.3%) experienced infection recurrence. These cases were effectively managed with a second round of endoscopic surgery [ 39 ]. Additionally, the observed decrease in systemic inflammation may contribute to a lower risk of recurrent infection, which is a critical consideration in managing pyogenic spondylitis. These results provide compelling evidence for integrating minimally invasive procedures into standard treatment protocols, potentially leading to better long-term outcomes and improved quality of life for patients. This study has several limitations, which must be considered. First, the sample size was relatively small, which may limit the generalizability of the findings. Larger sample sizes and multi-center studies could provide more robust evidence of the combined approach's efficacy. Second, the retrospective nature of the study design may introduce bias in data collection and analysis. Prospective studies with randomized controlled trials would better control for confounding variables and establish causality between treatment and outcomes. Finally, the follow-up period of at least one year may not capture long-term effects or potential late complications. Longer follow-up durations are needed to assess the durability and sustainability of treatment effects over time. Conclusion Minimally invasive endoscopic debridement combined with normal saline single-tube flushing is an effective approach for managing culture-negative primary pyogenic spondylitis. This technique demonstrates significant improvements in clinical outcomes and infection control, as evidenced by the comprehensive analysis of patient data. Declarations Ethics approval and consent to participate: This research received ethical approval from the First Hospital of Hebei Medical University Research Ethics Committee. Consent for publication: Informed consent was obtained from all individual participants included in the study. Funding: This work was supported by the Department of Hebei Health Commission (NO. 20221384), the Department of Hebei Health Commission (NO.20231073) and the Department of Hebei Health Commission (NO. 20250408) Author Contribution Authors' contributions: Conceived and designed the study: HYG; collected data: S.L, GBL, YGP, CHZ; analyzed the data: J.C, G.J, YJJ, FZ; wrote the paper: CPY, S.L. S.L, F. Z and YJJ contributed equally to this work. Acknowledgement We express our sincere gratitude to all the patients who participated in this study and to their families for their trust and support. We also thank the medical staff at the participating hospitals for their assistance in data collection and the provision of clinical information. Furthermore, we acknowledge the financial support provided by the funding agencies, which enabled us to conduct this research. Finally, we are grateful to the reviewers and editors for their valuable comments and suggestions, which have greatly improved the quality of this manuscript. Availability of data and material: All data generated or analysed during this study are included in this published article and its supplementary information files. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. All relevant raw data, not published within the article, will be made available by the authors, without undue reservation, to any qualified researcher. References Maddy KS, Tigre JY, Lu VM, Costello MC, Errante EL, Levi AD, Burks SS. Influence of instrumentation type on outcomes after surgical management of spondylodiscitis: a systematic review and meta-analysis. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical. 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European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical. Spine Res Soc. 2016;25:983–99. Masuda T, Miyamoto K, Hosoe H, Shimizu K. Comparative study on the efficacy of two-staged (posterior followed by anterior) surgical treatment using spinal instrumentation on pyogenic and tuberculotic spondylitis. Arch Orthop Trauma Surg. 2011;131:765–72. Lin CP, Ma HL, Wang ST, Liu CL, Yu WK, Chang MC. Surgical results of long posterior fixation with short fusion in the treatment of pyogenic spondylodiscitis of the thoracic and lumbar spine: a retrospective study. Spine. 2012;37:E1572–1579. Flierl MA, Beauchamp KM, Bolles GE, Moore EE, Stahel PF. Fatal outcome after insufficient spine fixation for pyogenic thoracic spondylodiscitis: an imperative for 360 degrees fusion of the infected spine. Patient Saf Surg. 2009;3:4. Lee CY, Huang TJ, Li YY, Cheng CC, Wu MH. Comparison of minimal access and traditional anterior spinal surgery in managing infectious spondylitis: a minimum 2-year follow-up. Spine J. 2014;14:1099–105. Wu S, Lin B, Li X, Chen S, Zhang H, Wu Z, Tang S, Yang Y, Liang B. Single-stage debridement via autogenous iliac bone graft through the OLIF corridor and lateral fixation in treating spontaneous single-level lumbar pyogenic spondylodiscitis. BMC Musculoskelet Disord. 2021;22:947. Turgut M. Complete recovery of acute paraplegia due to pyogenic thoracic spondylodiscitis with an epidural abscess. Acta Neurochir (Wien). 2008;150:381–6. Fu TS, Wang YC, Lin TY, Chang CW, Wong CB, Su JY. (2019) Comparison of Percutaneous Endoscopic Surgery and Traditional Anterior Open Surgery for Treating Lumbar Infectious Spondylitis. J Clin Med 8. Liu Y, Wu T, Tan J, Miao X, Tang T, Cai C, Li T, Luo X, Cheng X. Minimally Invasive versus Traditional Surgery: Efficacy of PELD and PLIF in Treating Pyogenic Spondylodiscitis. Med Sci Monit. 2024;30:e943176. Wang SF, Tsai TT, Li YD, Chiu PY, Hsieh MK, Liao JC, Lai PL, Kao FC. (2022) Percutaneous Endoscopic Interbody Debridement and Fusion (PEIDF) Decreases Risk of Sepsis and Mortality in Treating Infectious Spondylodiscitis for Patients with Poor Physical Status, a Retrospective Cohort Study. Biomedicines 10. Turel MK, Kerolus M, Deutsch H. The role of minimally invasive spine surgery in the management of pyogenic spinal discitis. J Craniovertebr Junction Spine. 2017;8:39–43. Griffith-Jones W, Nasto LA, Pola E, Stokes OM, Mehdian H. Percutaneous suction and irrigation for the treatment of recalcitrant pyogenic spondylodiscitis. J Orthop Traumatol. 2018;19:10. Xu J, Zhang L, Bu R, Liu Y, Lewandrowski KU, Zhang X. Minimally invasive debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis: a long-term follow-up study. BMC Musculoskelet Disord. 2021;22:120. Abreu PGP, Lourenço JA, Romero C, GN DA, Pappamikail L, Lopes MF, Brito M, Teles P, Correia JP. Endoscopic treatment of spondylodiscitis: systematic review. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical. Spine Res Soc. 2022;31:1765–74. Lin CY, Chang CC, Chen YJ, Tsai CH, Tsou HK, Lin CS, Ho MW, Chen HT, Hsu HC. New Strategy for Minimally Invasive Endoscopic Surgery to Treat Infectious Spondylodiscitis in the Thoracolumbar Spine. Pain Physician. 2019;22:281–93. Additional Declarations No competing interests reported. Supplementary Files RawData.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6241872","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":432807318,"identity":"37e7828b-2171-4773-8ab9-d39b10c45a96","order_by":0,"name":"Sen Liu","email":"","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Sen","middleName":"","lastName":"Liu","suffix":""},{"id":432807319,"identity":"55be8d85-b842-4b4e-a9f3-0a2fddd2e251","order_by":1,"name":"Chun-Ping Yin","email":"","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chun-Ping","middleName":"","lastName":"Yin","suffix":""},{"id":432807320,"identity":"f14a9696-b095-4268-a56a-845bbe87ef00","order_by":2,"name":"Yu-Jie Jin","email":"","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu-Jie","middleName":"","lastName":"Jin","suffix":""},{"id":432807321,"identity":"0f116bae-6db7-4a3a-aa41-bb212049bcf9","order_by":3,"name":"Chao-Hua Zhu","email":"","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chao-Hua","middleName":"","lastName":"Zhu","suffix":""},{"id":432807324,"identity":"3461bf34-d518-40be-a471-1b2edd82afa2","order_by":4,"name":"Yong-Gang Peng","email":"","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yong-Gang","middleName":"","lastName":"Peng","suffix":""},{"id":432807328,"identity":"a26de1f9-4501-4385-8d8a-c4ac4fcd0986","order_by":5,"name":"Gang Ji","email":"","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Gang","middleName":"","lastName":"Ji","suffix":""},{"id":432807330,"identity":"d753a2e9-d947-4a4c-ad50-7e072d8c360d","order_by":6,"name":"Jia Chen","email":"","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Chen","suffix":""},{"id":432807331,"identity":"ce6492ef-f840-418e-9625-034226d3239d","order_by":7,"name":"Feng Zhao","email":"","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Zhao","suffix":""},{"id":432807332,"identity":"7dc16421-a67c-4a62-8811-cc743231d5cd","order_by":8,"name":"Hong-Yang Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYHACNgaGAgY5Nvb2A6RoMWAw5uM5k0CalsR5Eg4GxKmXdz987DGPQV16mwRDAsOPim2EtRieSUs35jE4nNsm3XiAsefMbSK0NOSYSfMYHMhtkzmQwMzYRoyW/jcgLXXpbBIJBsRpkZcA28KcQLwWA4lnaZJzDA4btgED+SBRfpHvTz4m8aaiTl6+vf3ggx8VxNhygIGBiQfKOUBYPciWBgYGxh9EKR0Fo2AUjIIRCwBd0Dc+MMkMWAAAAABJRU5ErkJggg==","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hong-Yang","middleName":"","lastName":"Gao","suffix":""},{"id":432807333,"identity":"20a84307-2465-442b-a325-c906ea9b24fd","order_by":9,"name":"Guo-Bin Liu","email":"","orcid":"","institution":"First Affiliated Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Guo-Bin","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-03-17 07:08:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6241872/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6241872/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79575910,"identity":"0b8a9fce-56c9-40ea-98fc-c79a5cee5eb0","added_by":"auto","created_at":"2025-03-31 11:17:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88591,"visible":true,"origin":"","legend":"\u003cp\u003eThe device consists of two flushing catheters and a drainage catheter, all encased in a single-tube main tube with a diameter of 5.5 millimeters. The flushing and drainage tubes are connected to the physiological saline infusion set and negative pressure suction device, respectively, at their ends.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6241872/v1/e0777d9016b123749112eeee.jpg"},{"id":79575909,"identity":"514a4db9-68f2-4156-87ac-a701966adae4","added_by":"auto","created_at":"2025-03-31 11:17:38","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":99672,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTwo-year Radiological Follow-up Results of a Patient with Staphylococcus aureus Pyogenic Spondylitis.\u003c/strong\u003e\u003cbr\u003e\nA: MRI showing Type I abnormal signal in the vertebral endplate region and adjacent bone marrow, with corresponding intervertebral discs exhibiting either normal or degenerative changes consistent with adjacent discs.\u003cbr\u003e\nB: Three-month follow-up after treatment with Minimally Invasive Endoscopic Debridement combined with the Normal Saline Single-tube Flushing Device, showing significant improvement in inflammatory signals in the vertebral endplate region and adjacent bone marrow, with slight narrowing of the intervertebral space.\u003cbr\u003e\nC: Two-year follow-up post-surgery, showing sterile inflammatory changes in the L4-5 vertebral endplates on MRI T1 and T2 images, vertebral space destruction, and intervertebral disc degeneration.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6241872/v1/6268b9a250ba5fc787df8c45.jpg"},{"id":79577442,"identity":"47005a91-5c76-4b7e-86c9-82ff9b8488ae","added_by":"auto","created_at":"2025-03-31 11:25:38","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":122984,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA Patient with Culture-negative Pyogenic Spondylitis.\u003c/strong\u003e\u003cbr\u003e\nA-B: MRI showing Type III varying degrees of vertebral body and intervertebral disc destruction with abnormal signals.\u003cbr\u003e\nC-E: Minimally Invasive Endoscopic Debridement performed, with a plasma blade used to clear surrounding tissues. Significant destruction of the lower endplate of L4 and the upper endplate of L5 is revealed, with prominent scar tissue formation around the nerve roots, partial intervertebral disc protrusion, and removal of inflammatory tissue around the damaged endplates and intervertebral space.\u003cbr\u003e\nF-G: Hemostasis achieved with the plasma blade, followed by insertion of the Single-tube Flushing Device through the working channel. Postoperatively, the wound measures approximately 8mm in length and shows good healing.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6241872/v1/d8434d84d5424bb5d4921cd0.jpg"},{"id":99789840,"identity":"0632d4b3-b850-43cc-8e2b-48f926eac65a","added_by":"auto","created_at":"2026-01-08 12:50:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1113407,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6241872/v1/eabb9729-1068-4599-b4a1-f7fbbc9ef3fe.pdf"},{"id":79578413,"identity":"b3f6e2bd-86fa-499b-8750-0ebb83587141","added_by":"auto","created_at":"2025-03-31 11:33:38","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16668,"visible":true,"origin":"","legend":"","description":"","filename":"RawData.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6241872/v1/56e39a3cad808cc065aa586f.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy of Minimally Invasive Endoscopic Debridement combined with Normal Saline Single-tube Flushing Device on Single Segment Adults Primary Pyogenic Spondylitis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSpinal infection refers to the infection of the spine, intervertebral discs, and surrounding soft tissues caused by specific pathogenic microorganisms [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Based on the site of infection, it can be classified into vertebral body, intervertebral space, epidural space, paravertebral, and intraspinal infections [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In recent years, there has been an increase in the incidence of non-specific infections [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Risk factors for spinal infections fall into two main categories. The first is compromised immune function, with diabetes being significantly associated with higher mortality rates [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The second involves invasive procedures, such as needle puncture therapy, open surgery, and other interventions, which can lead to postoperative infections [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The overall incidence of pyogenic discitis ranges from 2.2 to 5.8 cases per 100,000 people annually, with culture-negative cases occurring at a rate of 0.3 to 1.8 cases and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e-related cases at 1.6 to 2.5 cases per 100,000 people per year [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Typical clinical symptoms of spinal infections include severe back pain, night pain, rest pain, and fever, with or without sciatica. Early radiographic findings often reveal pathological fractures, intervertebral disc space collapse, and, in some cases, vertebral endplate erosion or kyphosis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Diagnostic methods typically involve joint aspiration for synovial fluid analysis, blood cultures, and imaging studies such as X-rays or MRI. Treatment primarily involves aggressive antibiotic therapy, often administered intravenously, and may include surgical intervention to drain the infected joint. Rehabilitation and physical therapy are crucial for recovery and restoring joint function. Preventive strategies include managing underlying conditions such as diabetes or immunodeficiency disorders to reduce susceptibility to infections. Although antibiotic therapy is a cornerstone of treatment, early surgical intervention has been shown to significantly reduce mortality, recurrence rates, and hospital stays. The mortality rate for spinal infections can reach as high as 20%, underscoring the urgency of identifying the most effective treatment strategies. Compared to conservative management, early surgical intervention reduces recurrence or failure rates and mortality by 40% and 39%, respectively, while shortening hospital stays by an average of 7.75 days per patient [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious surgical treatments for lumbar disc infections have included incision, debridement, irrigation, and drainage combined with internal fixation, as well as puncture, minimally invasive surgery, open surgery, lesion removal, intervertebral grafting, and fusion. While these approaches have demonstrated satisfactory clinical outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], they also have notable drawbacks, such as prolonged operation times, significant trauma, and slow postoperative recovery. Additionally, some patients with compromised health conditions are unable to tolerate incision, debridement, and drainage procedures [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The percutaneous foraminal endoscopic technique, characterized by its simplicity, safety, and minimally invasive nature, has been increasingly utilized not only for treating lumbar disc herniation but also for managing lumbar space infections [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This technique offers a promising alternative, particularly for patients with poor health who cannot endure more invasive procedures. It has shown potential in reducing operation times, minimizing tissue damage, and accelerating postoperative recovery. Furthermore, its versatility has expanded its application to various spinal conditions, broadening the scope of minimally invasive spinal surgery. Preliminary studies have reported high patient satisfaction and improved clinical outcomes, reinforcing its efficacy and safety. As research progresses, this technique is expected to further refine treatment protocols and emerge as a standard approach for managing lumbar space infections and other spinal pathologies.\u003c/p\u003e \u003cp\u003eIn recent years, percutaneous endoscopic debridement combined with external drainage has been validated as an effective treatment for lumbar disc infections. However, despite its growing adoption, traditional irrigation and drainage methods often rely on individual incisions and tubing, which can increase tissue trauma and the risk of infection [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, mid-term efficacy studies on endoscopic treatment of lumbar disc infections remain limited. This study aims to evaluate the efficacy of minimally invasive endoscopic debridement combined with an original incision normal saline single-tube flushing device for treating single-segment primary pyogenic spondylitis in adults. Through a retrospective analysis, the findings seek to provide valuable insights for clinical practitioners and contribute to the advancement of surgical management strategies for this complex condition.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed clinical data from 21 adult patients with single-segment primary pyogenic spondylitis who were admitted between January 2016 and January 2022. The primary objective was to evaluate the efficacy of minimally invasive endoscopic debridement combined with a normal saline single-tube flushing device for managing this condition.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe study included 21 adult patients diagnosed with single-segment primary pyogenic spondylitis, comprising 9 males and 12 females, with a mean age of 52 years. All patients underwent minimally invasive endoscopic debridement combined with normal saline single-tube flushing.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003ePreoperative data, including patient demographics and basic surgical information, were collected and analyzed. Postoperative parameters such as the duration of continuous irrigation, time to mobilization, length of hospital stay, infection indicators, hospital expenses, pain scores, and functional status were monitored at various postoperative intervals.\u003c/p\u003e \u003cp\u003eInfection indicators included white blood cell count, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, interleukin-6, procalcitonin, blood culture, bacterial culture of lesion tissues obtained during surgery, pathological examination, Brucella tube agglutination test, T-spot test, tissue pathology TB-DNA positivity, X-pert, and metagenomic next-generation sequencing (mNGS). These indicators were monitored at multiple time points within three months postoperatively.\u003c/p\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cp\u003eThe overall treatment efficacy was assessed using Visual Analog Scale (VAS) scores for pain, Japanese Orthopaedic Association (JOA) scores and improvement rates, and Oswestry Disability Index (ODI) scores for functional status. Data were collected for a minimum follow-up period of one year for all patients.\u003c/p\u003e\n\u003ch3\u003eSurgical Procedure\u003c/h3\u003e\n\u003cp\u003ePercutaneous endoscopic debridement and drainage (PEDD) were performed using the Yeung Endoscopic Spinal System (Richard Wolf GmbH, Knittlingen, Germany) via a posterolateral percutaneous approach. Sedation was administered by anesthesiologists locally, with the patient remaining awake. All patients were placed in the prone position. Under intraoperative fluoroscopy guidance, a needle was initially inserted into the infected region, and the abscess was aspirated and sent for culture.\u003c/p\u003e \u003cp\u003eNext, a guidewire was introduced into the intervertebral disc space, and the needle was removed. A small skin incision (approximately 0.5 to 1 cm) was made, followed by the insertion of dilators and working cannulas. The guidewires were sequentially advanced into the disc spaces. Once the cannula position was confirmed, its tip was observed penetrating the tissue under fluoroscopy, and biopsy samples were collected. Nucleotomy forceps were inserted through the dilators to extract additional tissue. The intervertebral disc infection was monitored using fluorescence. Necrotic intervertebral disc tissue and any areas of endplate destruction in the adjacent vertebral bodies were removed as extensively as possible. Finally, a single flushing tube (5 mm in diameter), including two inflow tubes and a drainage tube, was inserted through the skin incision into the debrided disc space and connected to a negative pressure pump.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative Care\u003c/h2\u003e \u003cp\u003ePostoperatively, for 1 to 5 days, intravenous diuretics in small doses were administered to alleviate muscle, soft tissue, and nerve damage caused by traction, peeling, and edema during surgery. Oral muscle relaxants, analgesics, gastric protectants, and neurotrophic drugs were prescribed to promote recovery. The surgical incision and drainage were closely monitored, with dressing changes performed 1 to 2 times daily.\u003c/p\u003e \u003cp\u003eThe drainage tube was flushed continuously with physiological saline (0.9% sodium chloride) at a flow rate of 40 to 60 drops per minute for 1 week, or until the drainage fluid became clear for three consecutive days. While bedridden, patients were instructed to exercise their lung function by blowing a balloon and to elevate and move their lower limbs to prevent deep vein thrombosis.\u003c/p\u003e \u003cp\u003eAfter the drainage tube was removed, patients were instructed to wear a waistband for support during ground activity. Sensitive antibiotics were administered for 12 weeks based on drug sensitivity results. In cases where pathogens were not detected in the biopsy cultures of infected tissue, empiric antibiotics were used.\u003c/p\u003e \u003cp\u003eAfter discharge, patients were instructed to keep the surgical incision dry and change the dressing 2 to 3 times daily. Stitches were removed 14 days after surgery, and patients with osteoporosis were advised to start anti-osteoporosis treatment. For at least 3 months post-discharge, patients were instructed to wear a waistband while getting out of bed and moving around. Regular monitoring of infection indicators, including white blood cells, C-reactive protein, and erythrocyte sedimentation rate, was recommended. Additionally, postoperative re-examinations, including lumbar spine X-rays, MRI, and CT scans, were performed to assess the lesions and spinal stability.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNormal Saline Single-tube Flushing Device\u003c/h3\u003e\n\u003cp\u003eA single-tube flushing device was used to treat early incision infections following lumbar spine surgery (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The device consists of two flushing catheters and a drainage catheter, all wrapped within a single main tube with a diameter of 5.5 millimeters. The flushing and drainage tubes are connected at their ends to a physiological saline infusion set and a negative pressure suction device, respectively. The tail end of the flushing catheter is connected to the flushing liquid bottle, while the tail end of the drainage catheter is linked to the top of the negative pressure suction ball.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis single-tube flushing device requires only one tube and channel to achieve sufficient flushing and drainage of the deep wound surface, effectively controlling infection without the need for a double-tube, double-channel system. Its advantages include a simple structure, rational design, and low manufacturing cost.\u003c/p\u003e\n\u003ch3\u003eRadiological Assessment\u003c/h3\u003e\n\u003cp\u003eMRI appearances were classified according to the following criteria [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] as follows: Type I: MRI shows mild abnormal signals in the vertebral endplate region and adjacent bone marrow, with corresponding intervertebral discs showing either normal or degenerative changes consistent with adjacent discs. Type II: MRI findings include narrowing of the intervertebral space, collapse, and fragmentation of the intervertebral disc, with T2-weighted imaging (T2WI) showing significantly high signal intensity. Type III: Varying degrees of vertebral body and intervertebral disc destruction with abnormal signals. Type IV: Soft tissue swelling around the small joints with unclear boundaries, possible abscess formation, and erosive destruction visible in adjacent bone tissue.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were conducted using paired t-tests and independent samples t-tests. Independent samples t-tests were used to compare measurement data between two groups, while paired samples t-tests were used to compare preoperative and postoperative measurement data. Chi-square tests were applied to analyze count data. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. All statistical analyses were performed using SPSS software version 23.0 (SPSS Inc., Chicago, Illinois).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAll 21 patients were followed up, and no recurrence of lumbar disc space infection was observed. Microbiological culture results revealed that 16 cases were confirmed as bacterial culture-positive pyogenic spondylitis, while 5 cases were culture-negative pyogenic spondylitis. The average duration of continuous irrigation was 6.29 days, and the average time to mobilize was 3.33 days (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Based on MRI findings, four types of infection were identified: Type I (7 cases), Type II (4 cases), Type III (6 cases), and Type IV (4 cases) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Main Demographic Variables of Patients Before Surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimum value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaximum value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e47.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e23.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e97.10\u0026thinsp;\u0026plusmn;\u0026thinsp;21.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncision length (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e50.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of weight-bearing (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eInfection Indicators\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eThree days and one week after surgery, white blood cell count, neutrophil percentage, C-reactive protein, and erythrocyte sedimentation rate were significantly lower than preoperative levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These values continued to decrease after one month postoperatively and returned to baseline levels (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of Infection indicators\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003epostoperative\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 days\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 days\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood cell count(10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04*#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98*#◆\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67*#◆\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophil percentage (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49*#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.03*#◆\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09*#◆◇\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75.55\u0026thinsp;\u0026plusmn;\u0026thinsp;11.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.30\u0026thinsp;\u0026plusmn;\u0026thinsp;8.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.76\u0026thinsp;\u0026plusmn;\u0026thinsp;9.00*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.41\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39*#◆\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39*#◆◇\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESR (mm/h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.25\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.84\u0026thinsp;\u0026plusmn;\u0026thinsp;7.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.17\u0026thinsp;\u0026plusmn;\u0026thinsp;9.98*#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74*#◆\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60*#◆◇\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eNote: \u0026ldquo;*\u0026rdquo; There were statistically significant differences compared to preoperative conditions. \u0026ldquo;#\u0026rdquo; Statistically significant differences were observed at 7 days postoperatively. \u0026ldquo;◆\u0026rdquo; Statistically significant differences were observed at 1 month postoperatively. \u0026ldquo;◇\u0026rdquo; Statistically significant differences were observed at 3 months postoperatively. The differences were significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eVAS Score\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eAt one week, one month, three months postoperatively, and at the final follow-up, the VAS scores were all significantly lower than preoperative levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). A gradual decrease in scores was observed at each postoperative time point, with statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Evaluation of VAS score and Functional status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003epostoperative\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 days\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFinal follow-up\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22*#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44*#◆\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54*#◆\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.72\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.94\u0026thinsp;\u0026plusmn;\u0026thinsp;5.79*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.09*#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90*#◆\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43*#◆◇\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJOA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80*#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05*#◆\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33*#◆\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJOA\u003c/p\u003e \u003cp\u003eimprovement Rate (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.12\u0026thinsp;\u0026plusmn;\u0026thinsp;8.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.85#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81.32\u0026thinsp;\u0026plusmn;\u0026thinsp;10.54#◆\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70#◆◇\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eNote: \u0026ldquo;*\u0026rdquo; There were statistically significant differences compared to preoperative conditions. \u0026ldquo;#\u0026rdquo; Statistically significant differences were observed at 7 days postoperatively. \u0026ldquo;◆\u0026rdquo; Statistically significant differences were observed at 1 month postoperatively. \u0026ldquo;◇\u0026rdquo; Statistically significant differences were observed at 3 months postoperatively. The differences were significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eFunctional Status\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eJOA Score\u003c/strong\u003e \u003cp\u003eAt one week, one month, three months postoperatively, and at the final follow-up, the JOA scores were significantly higher than preoperative levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with a gradual increase at each time point showing statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The improvement rate of the JOA score at the final follow-up was 86.05%.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eODI Score\u003c/strong\u003e \u003cp\u003eAt one week, one month, three months postoperatively, and at the final follow-up, the ODI scores were significantly lower than preoperative levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), showing statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eMinimally invasive endoscopic debridement combined with a normal saline single-tube flushing device has demonstrated favorable outcomes in the treatment of culture-negative primary pyogenic spondylitis. The results of this study suggest that this combined approach can lead to improved clinical outcomes, including pain relief, enhanced functional status, and effective infection control in adult patients with single-segment primary pyogenic spondylitis.\u003c/p\u003e \u003cp\u003eDelayed treatment of pyogenic spondylitis can result in the spread of infection, and in cases where bacterial virulence is strong and the disease progresses rapidly, it may lead to severe complications such as septicemia, septic shock, intracranial infection, respiratory failure, and high mortality rates ranging from 2\u0026ndash;17% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Regardless of the patient's hemodynamic stability, prompt microbiological diagnosis and initiation of antibiotic therapy are crucial. Empirical antibiotic therapy should be avoided until the pathogen is identified [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The positivity rate of microbiological testing is a key factor influencing prognosis. Appropriate antimicrobial therapy, when standardized and administered for a sufficient duration, is essential for controlling infections [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTraditional methods for pathogen identification include blood cultures, CT-guided biopsies, and open surgery. However, blood cultures have a low pathogen detection rate, and CT-guided biopsies face limitations in specimen collection due to restricted operative space, with a sensitivity of 30%-74% [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Open surgery provides the advantage of obtaining more pathological tissue for microbiological analysis, along with debridement and fixation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, it carries risks such as wound non-healing, sinus formation, implant infection, and fusion device infection [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In some cases, repeated debridement surgeries are required until the implant is removed to effectively control the infection.\u003c/p\u003e \u003cp\u003eWith the advancement of minimally invasive techniques, these methods can also provide sufficient pathological tissue, increase pathogen detection rates, and offer a promising alternative for treating intervertebral space infections. The treatment of vertebral pyogenic spondylodiscitis typically involves addressing the anterior part of the vertebral body, which is primarily infected and damaged. The formation of epidural abscesses or sequestrated bone at the affected site often leads to compression of the dura mater [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Consequently, many surgeons prefer anterior decompression for debridement of vertebral osteomyelitis followed by autologous bone grafting, with the anterior lateral approach being commonly used. However, anterior decompression surgery has several drawbacks, including prolonged postoperative bed rest, the need for auxiliary support, limitations in lumbar spine application, potential impact on lung function with thoracotomy, and risks of graft collapse or subsidence leading to kyphosis [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost researchers agree that the posterior elements of the vertebrae maintain a certain degree of stability, whereas vertebral body decompression surgery may further compromise spinal stability [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Minimally invasive surgery, due to its natural passage, does not disrupt the vertebral plate and facet joint, thus preserving the integrity of the posterior column of the vertebrae while performing debridement and drainage of intervertebral abscesses. Fu et al. found that, compared to traditional anterior open surgery, percutaneous endoscopic surgery significantly reduces blood loss and shortens hospital stay. Additionally, the normalization rate of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) is faster [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCompared with traditional posterior lumbar interbody fusion (PLIF) surgery, percutaneous endoscopic lumbar discectomy (PELD) has been reported to have advantages such as shorter operation time, less intraoperative blood loss, and shorter hospital stay. Significant improvements in postoperative inflammatory markers (such as ESR and CRP levels) and neurological function (ASIA grade) were observed following PELD surgery, although the differences between the two groups were not statistically significant. Furthermore, patients in the PLIF group showed significant improvements in intervertebral space height and lumbar lordosis angle [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn terms of inflammation control, the results of this study indicate that percutaneous endoscopic lumbar discectomy effectively controls ESR and CRP levels, with values returning to baseline within three months. However, for patients with poor physical conditions who are suffering from infectious spondylitis, percutaneous endoscopic debridement and fusion may be a better option, as it can significantly reduce the risk of sepsis and mortality. A retrospective cohort study by Wang et al. demonstrated that percutaneous endoscopic debridement and fusion (PEIDF) can reduce the risk of sepsis and mortality in patients with infectious spondylitis who have poor physical conditions [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, all patients underwent single-tube drainage with an original incision, utilizing a 5mm diameter tube with two inflow tubes and one drainage tube. This device was inserted into the intervertebral disc space through the skin incision, achieving favorable outcomes. Literature indicates that methods for draining purulent fluid in spinal infections include percutaneous aspiration, lesion puncture under CT guidance, and catheter drainage, all of which have shown satisfactory results for treating lumbar vertebrae infections [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Xu et al. reported that intraoperative CT-guided minimally invasive percutaneous debridement and lavage is an effective method for treating multilevel intervertebral discitis. This technique uses CT guidance to enter the intervertebral disc space through a percutaneous incision for debridement and lavage, contributing to therapeutic efficacy [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. However, simple catheter irrigation and drainage may not directly remove diseased tissue, and drainage failure can occur due to the viscous nature of purulent fluid. The single-tube drainage device used in this study, compared to traditional multi-incision drainage, provides effective drainage while reducing skin trauma and lowering the risk of infection. Postoperative assessments showed notable reductions in inflammatory markers such as neutrophil percentage, C-reactive protein, and erythrocyte sedimentation rate, indicating the successful resolution of the inflammatory response. These findings highlight the therapeutic benefits of the minimally invasive approach in reducing the systemic inflammatory burden associated with pyogenic spondylitis.\u003c/p\u003e \u003cp\u003eThe results of this study support the effectiveness of minimally invasive endoscopic debridement combined with a normal saline single-tube flushing device for treating single-segment adult primary pyogenic spondylitis. Clinical improvements were observed across multiple outcome measures, including VAS scores for pain, JOA scores, and ODI for functional status, at multiple postoperative time points, including the final follow-up. These improvements suggest the potential effectiveness of the combined treatment approach.\u003c/p\u003e \u003cp\u003eAbreu et al. conducted an analysis of 342 participants, reporting microbial identification rates ranging from 54.2\u0026ndash;90.4%, and treatment failure rates from 0\u0026ndash;33%. The study showed satisfactory improvements in pain, functional status, and postoperative neurological deficits [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. A key finding in our study was the absence of lumbar disc space infection recurrence during the follow-up period, demonstrating the potential of the combined treatment approach in preventing disease relapse. This aligns with previous studies that emphasize the advantages of minimally invasive techniques in reducing postoperative complications and enhancing patient satisfaction. Lin et al. reported that among 34 patients undergoing minimally invasive endoscopic surgery for infectious spondylodiscitis, 2 patients (3.3%) experienced infection recurrence. These cases were effectively managed with a second round of endoscopic surgery [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Additionally, the observed decrease in systemic inflammation may contribute to a lower risk of recurrent infection, which is a critical consideration in managing pyogenic spondylitis. These results provide compelling evidence for integrating minimally invasive procedures into standard treatment protocols, potentially leading to better long-term outcomes and improved quality of life for patients.\u003c/p\u003e \u003cp\u003eThis study has several limitations, which must be considered. First, the sample size was relatively small, which may limit the generalizability of the findings. Larger sample sizes and multi-center studies could provide more robust evidence of the combined approach's efficacy. Second, the retrospective nature of the study design may introduce bias in data collection and analysis. Prospective studies with randomized controlled trials would better control for confounding variables and establish causality between treatment and outcomes. Finally, the follow-up period of at least one year may not capture long-term effects or potential late complications. Longer follow-up durations are needed to assess the durability and sustainability of treatment effects over time.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMinimally invasive endoscopic debridement combined with normal saline single-tube flushing is an effective approach for managing culture-negative primary pyogenic spondylitis. This technique demonstrates significant improvements in clinical outcomes and infection control, as evidenced by the comprehensive analysis of patient data.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e This research received ethical approval from the First Hospital of Hebei Medical University Research Ethics Committee.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis work was supported by the Department of Hebei Health Commission (NO. 20221384), the Department of Hebei Health Commission (NO.20231073) and the Department of Hebei Health Commission (NO. 20250408)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthors' contributions: Conceived and designed the study: HYG; collected data: S.L, GBL, YGP, CHZ; analyzed the data: J.C, G.J, YJJ, FZ; wrote the paper: CPY, S.L. S.L, F. Z and YJJ contributed equally to this work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe express our sincere gratitude to all the patients who participated in this study and to their families for their trust and support. We also thank the medical staff at the participating hospitals for their assistance in data collection and the provision of clinical information. Furthermore, we acknowledge the financial support provided by the funding agencies, which enabled us to conduct this research. Finally, we are grateful to the reviewers and editors for their valuable comments and suggestions, which have greatly improved the quality of this manuscript.\u003c/p\u003e\u003ch2\u003eAvailability of data and material:\u003c/h2\u003e \u003cp\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. All relevant raw data, not published within the article, will be made available by the authors, without undue reservation, to any qualified researcher.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMaddy KS, Tigre JY, Lu VM, Costello MC, Errante EL, Levi AD, Burks SS. Influence of instrumentation type on outcomes after surgical management of spondylodiscitis: a systematic review and meta-analysis. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical. Spine Res Soc. 2024;33:3175\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi SH, Koo JW, Hur JM, Kang CN. 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(2019) Comparison of Percutaneous Endoscopic Surgery and Traditional Anterior Open Surgery for Treating Lumbar Infectious Spondylitis. J Clin Med 8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu Y, Wu T, Tan J, Miao X, Tang T, Cai C, Li T, Luo X, Cheng X. Minimally Invasive versus Traditional Surgery: Efficacy of PELD and PLIF in Treating Pyogenic Spondylodiscitis. Med Sci Monit. 2024;30:e943176.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang SF, Tsai TT, Li YD, Chiu PY, Hsieh MK, Liao JC, Lai PL, Kao FC. (2022) Percutaneous Endoscopic Interbody Debridement and Fusion (PEIDF) Decreases Risk of Sepsis and Mortality in Treating Infectious Spondylodiscitis for Patients with Poor Physical Status, a Retrospective Cohort Study. Biomedicines 10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurel MK, Kerolus M, Deutsch H. The role of minimally invasive spine surgery in the management of pyogenic spinal discitis. 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Spine Res Soc. 2022;31:1765\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin CY, Chang CC, Chen YJ, Tsai CH, Tsou HK, Lin CS, Ho MW, Chen HT, Hsu HC. New Strategy for Minimally Invasive Endoscopic Surgery to Treat Infectious Spondylodiscitis in the Thoracolumbar Spine. Pain Physician. 2019;22:281\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Minimally Invasive, Endoscopic Debridement, Single-tube Flushing, Pyogenic Spondylitis","lastPublishedDoi":"10.21203/rs.3.rs-6241872/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6241872/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo assess the efficacy of minimally invasive endoscopic debridement combined with normal saline single-tube flushing compared to traditional dual-tube flushing for treating single-segment primary pyogenic spondylitis in adults.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on clinical data from 21 adult patients with single-segment primary pyogenic spondylitis admitted between January 2016 and January 2022. The cohort included 9 males and 12 females, with a mean age of 48 years. All patients underwent minimally invasive endoscopic debridement combined with normal saline single-tube flushing. Data on surgical details, hospital stay duration, hospital expenses, infection indicators, and treatment outcomes\u0026mdash;including Visual Analog Scale (VAS) scores for pain, Japanese Orthopaedic Association (JOA) scores and improvement rates, and Oswestry Disability Index (ODI) for functional status\u0026mdash;were collected and analyzed over a minimum follow-up period of one year.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAll 21 patients completed follow-up, with no recurrence of lumbar disc space infection. Bacterial cultures and second-generation sequencing results were negative for all patients. The mean duration of continuous irrigation was 6.29 days, and the average time to mobilization was 3.33 days. Neutrophil percentage, C-reactive protein levels, and erythrocyte sedimentation rates were significantly lower three days and one week postoperatively compared to preoperative levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These indicators continued to decline and returned to baseline levels within one month postoperatively. VAS and ODI scores showed significant improvement at one week, one month, three months, and the final follow-up compared to preoperative levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with consistent improvement over time. Similarly, JOA scores increased significantly at the same postoperative intervals (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with an improvement rate of 86.05% at the final follow-up.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMinimally invasive endoscopic debridement combined with normal saline single-tube flushing is an effective approach for managing culture-negative primary pyogenic spondylitis. This technique demonstrates significant improvements in clinical outcomes and infection control, as evidenced by the comprehensive analysis of patient data.\u003c/p\u003e\u003ch2\u003eLevel of Evidence\u003c/h2\u003e \u003cp\u003eLevel 3\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eRetrospectively registered\u003c/p\u003e","manuscriptTitle":"Efficacy of Minimally Invasive Endoscopic Debridement combined with Normal Saline Single-tube Flushing Device on Single Segment Adults Primary Pyogenic Spondylitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 11:17:34","doi":"10.21203/rs.3.rs-6241872/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cbcd49a9-21af-401f-928a-e8efa8c159da","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-03T12:08:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-31 11:17:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6241872","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6241872","identity":"rs-6241872","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}