Effectiveness and safety of percutaneous endoscopic debridement and drainage for spinal infections: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Spinal infections (SI) typically manifest with and pose a growing medical challenge. However, current evidence for treating SI is limited and inconclusive. Our aim was to assess the effectiveness and safety of percutaneous endoscopic disc decompression (PEDD) for SI. METHODS: On 20 October 2023, we searched the EMBASE, PubMed, Cochrane Library, China Biology Medicine Disc, China National Knowledge Infrastructure, and Wanfang databases for eligible studies. Cohort studies on SI treated with PEDD, reporting relevant effectiveness or safety outcomes. We assessed study quality using a modified Newcastle-Ottawa Scale and conducted a random-effects meta-analysis to calculate pooled results. RESULTS: Overall, 36 studies involving 925 patients were included. Erythrocyte sedimentation rate levels decreased significantly at 1-week postoperatively compared with preoperative levels (mean difference [MD] = - 13.48 [95% CI - 15.65 to - 11.31]) and continued to decrease over 3 months. Similarly, the c-reactive protein (CRP), visual analogue scale, and oswestry disability index scores significantly reduced postoperatively. The rates of excellent or good MacNab classification were 92.6% (95% CI 84.1-98.1%). Microbiological diagnostics revealed a 71.7% (95% CI 65.5-77.6%) positive rate in tissue cultures, surpassing blood cultures (odds ratio [OR] 2.72 [95% CI 1.01-7.30]). The rates of complication, reoperation, and mortality were 4.1% (95% CI 1.5-8.0%), 8.6% (95% CI 4.3-14.3%), and 1.7% (95% CI 0.4-4.1%), respectively. Subgroup analyses demonstrated a significantly lower reoperation rate in the group that discontinued antibiotics based on a normal CRP than in the fixed-duration group (2.7% [95% CI 0.3-7.7%] vs 20.1% [95% CI 14.5-26.3%], p = 0.0002). Conversely, ambulation 1 day postoperatively was associated with a higher reoperation rate than ambulation within 5-14 days (16.2% [95% CI 9.3-24.6%] vs 1.1% [95% CI 0.0-6.0%], p = 0.0060). CONCLUSION: Our meta-analysis suggests that PEDD is a potentially effective and safe intervention for SI. Optimizing antibiotic discontinuation and postoperative care strategies may contribute to reducing reoperation rate. However, these findings require further validation from controlled studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.040 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".