## 3 Results
### Case Series
Figure 5: Intra-operative view of a fully endoscopic debridement of an epidural abscess. confirming the reduction in inflammatory changes in the spine. Despite the initial spike in inflammatory markers, the patient responded well to empirical antibiotic therapy, underscoring the effectiveness of the combined endoscopic and stabilization approach in treating spinal infections complicated by abscess formation. 8.2 Case Description No. 2: Post-Operative Spinal Infection in a 70-Year-Old Male with Diabetes and Chronic Renal Failure  
Patient Background: A 70-year-old male patient with a history of diabetes and chronic renal failure was scheduled for surgical treatment of discopathy at the L3/L4 level (Figure 6). The patient underwent microdiscectomy using a minimally invasive access retractor Spotlight (Johnson and Johnson, New Brunswick, NJ, USA). Post-operative Course: Initially, the patient reported significant pain relief and was mobilized and discharged home. However, two weeks post-discharge, he presented with copious watery discharge from the surgical wound. Diagnostic Evaluation: Upon admission, the patient's inflammatory markers were significantly elevated (CRP > 490 mg/L, procalcitonin = 1.13 ng/ML). An urgent re-operation was indicated due to the presence of inflammatory changes extending to the spinal canal. Cultures were taken, the wound was cleaned, and a drain was placed. Empirical antibiotic therapy with vancomycin, ceftrixone, and metronidazoleae was initiated. Culture results later revealed an MSSA (Methicillin-Sensitive _Staphylococcus aureus_) infection, prompting the inclusion of cloxacillin and amikacin in the treatment regimen. Clinical Challenges: Despite a decrease in inflammatory markers, the patient continued to experience severe pain that hindered mobilization, accompanied by persistent wound discharge. Follow-up MRI indicated persistent stenosis at the operated level, likely due to post-operative and inflammatory changes. A decision for further revision was made, leading to extensive decompression through laminotomy and removal of the entire ligamentum flavour at that level. An incidental dural tear occurred during the procedure and was sealed with Tachosil. Subsequent Complications: Although there was temporary clinical improvement, acute pain returned after a few days. Two weeks later, the wound healed and the drain was removed, but the patient still reported disabling pain and exhibited a worsening of  
Figure 6: Pre-operative T2 sagittal MRI image at the L3/L4. renal parameters due to the exacerbation of chronic renal failure, attributed to prolonged antibiotic therapy. Inflammatory markers rose again. Further Intervention: Another MRI confirmed that despite extensive decompression, significant narrowing persisted at the operated level, with a markedly increased T2 signal in the disc space (Figure 7). A subsequent endoscopic transforminal approach was employed. Inflammatory disc material and granulation tissue from the spinal canal were removed. Post-operative MRI showed a satisfactory degree of decompression of the canal. The patient was mobilized and transferred to the nephrology department due to further deterioration of renal function. Long-term Outcome: Two months later, after stabilization of his renal condition, the patient underwent control diagnostics. MRI results were satisfactory, and clinically, the patient was able to move with the assistance of a walker (Figure 8). The pain was moderate and allowed for relatively normal functioning. The patient was referred to the rehabilitation department for further improvement. 8.3 Case Description No. 3: Spondylosicitis in an HIV-Positive Patient, Endoscopic Revision Following Previous MISS Treatment  
Patient Background: A 35-year-old male, known to be HIV-positive, was diagnosed due to dull pain in the thoracic spine. MRI diagnostics revealed a pathological fracture at  
Figure 8: T2 axial MRI image at the L4/L5 level following previous transforminal endoscopic debridement.