Full-endoscopic-assisted retroperitoneal approach for the devastating spondylodiscitis with psoas abscess.

Introduction: Spondylodiscitis with psoas abscess is a serious spinal infection often requiring prolonged antibiotics and surgery in some instances. Conventional surgical approaches can be highly invasive, posing significant risks to frail patients with multiple comorbidities. An endoscopic-assisted retroperitoneal approach offers a potential minimally invasive alternative to reduce surgical trauma. Research question: Can an endoscopic-assisted retroperitoneal approach effectively and safely treat spondylodiscitis with psoas abscess, particularly in high-risk patients? Materials and methods: This retrospective case series included patients treated for psoas abscess via an endoscopic-assisted retroperitoneal approach between 2013 and 2023. The collected data included demographic details, comorbidities, operative time, blood loss, postoperative pain scores, spinal injury scale outcomes, time to normalization of laboratory markers, and 6-month satisfaction scores. Results: Of 81 patients with spinal infections who underwent surgery, nine met the inclusion criteria (mean age 65.67 ± 10.6 years). Spinal stabilization was performed in seven cases. Mean operative time was 149.44 ± 63.05 min, and mean blood loss was 88.89 ± 117.59 mL. Significant pain reduction was observed postoperatively, and 88.89 % of patients maintained or improved spinal injury scores at 1-year follow-up. Laboratory markers normalized within 1 week to 1 month in most cases. At 6 months, 77.78 % reported good to excellent satisfaction. Discussion and conclusion: The endoscopic-assisted retroperitoneal approach is a feasible and promising option for managing spondylodiscitis with psoas abscess, offering reduced tissue damage, favorable recovery times, and encouraging clinical outcomes. It may be particularly advantageous for frail patients with multiple comorbidities.