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Zhang Z, Hao Y, Wang X, Zheng Z, Zhao X, Wang C, Zhang X, Zhang X. Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis - a long-term retrospective study of 106 cases. BMC Musculoskelet Disord 2020; 21:353. [PMID: 32505204 PMCID: PMC7276089 DOI: 10.1186/s12891-020-03344-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy. Methods A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI). Results The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination. Conclusion MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
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Affiliation(s)
- Zhifa Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Yongyu Hao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xiangyu Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Zhirong Zheng
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xuelin Zhao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Chunguo Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xifeng Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
| | - Xuesong Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
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Dave BR, Kurupati RB, Shah D, Degulamadi D, Borgohain N, Krishnan A. Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique. Indian J Orthop 2014; 48:67-73. [PMID: 24600066 PMCID: PMC3931156 DOI: 10.4103/0019-5413.125506] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Percutaneous aspiration of abscesses under ultrasonography (USG) and computer tomography (CT) scan has been well described. With recurrence rate reported as high as 66%. The open drainage and percutaneous continuous drainage (PCD) has reduced the recurrence rate. The disadvantage of PCD under CT is radiation hazard and problems of asepsis. Hence a technique of clinically guided percutaneous continuous drainage of the psoas abscess without real-time imaging overcomes these problems. We describe clinically guided PCD of psoas abscess and its outcome. MATERIALS AND METHODS Twenty-nine patients with dorsolumbar spondylodiscitis without gross neural deficit with psoas abscess of size >5 cm were selected for PCD. It was done as a day care procedure under local anesthesia. Sequentially, aspiration followed by guide pin-guided trocar and catheter insertion was done without image guidance. Culture sensitivity was done and chemotherapy initiated and catheter kept till the drainage was <10 ml for 48 hours. Outcome assessment was done with relief of pain, successful abscess drainage and ODI (Oswestry Disability Index) score at 2 years. RESULTS PCD was successful in all cases. Back and radicular pain improved in all cases. Average procedure time was 24.30 minutes, drain output was 234.40 ml, and the drainage duration was 7.90 days. One patient required surgical stabilisation due to progression of the spondylodiscitis resulting in instability inspite of successful drainage of abscess. Problems with the procedure were noticed in six patients. Multiple attempts (n = 2), persistent discharge (n = 1) for 2 weeks, blocked catheter (n = 2) and catheter pull out (n = 1) occurred with no effect on the outcome. The average ODI score improved from 62.47 to 5.51 at 2 years. CONCLUSIONS Clinically guided PCD is an efficient, safe and easy procedure in drainage of psoas abscess.
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Affiliation(s)
- Bharat R Dave
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Ranganatha Babu Kurupati
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Dipak Shah
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Devanand Degulamadi
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Nitu Borgohain
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
| | - Ajay Krishnan
- Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India
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Childs DD, Tchelepi H. Ultrasound and Abdominal Intervention: New Luster on an Old Gem. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.cult.2009.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Park MY, Park JY, Yu JY, Kim SS, Kim MS, Kim JC, Ahn CJ. A Case of Tuberculous Psoas Abscess Caused by Tuberculous Lymphadenopathy. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.65.6.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mi Youn Park
- Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Jin Young Park
- Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Ji Youn Yu
- Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Seung Su Kim
- Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Myung Sook Kim
- Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Ji Chang Kim
- Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Chang Joon Ahn
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
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Tanomkiat W, Buranapanitkit B. Percutaneous drainage of large tuberculous iliopsoas abscess via a subinguinal approach: a report of two cases. J Orthop Sci 2004; 9:157-61. [PMID: 15045544 DOI: 10.1007/s00776-003-0760-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2003] [Accepted: 10/31/2003] [Indexed: 10/26/2022]
Abstract
Two patients who had large tuberculous abscesses that were successfully treated with percutaneous drainage alone are reported. A new approach, called the "subinguinal approach," was used. This new technique avoids the bowel loops and pelvic organs (which can be limitations when using the anterior abdominal approach) by inserting the catheter through the subinguinal portion of the psoas muscle into the abscess. Compared to the posterior approach, this technique is more comfortable for the patient (who prefers a supine position) and is not limited by the iliac bone. The technique, clinical course, and outcome are described.
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Affiliation(s)
- Wiwatana Tanomkiat
- Diagnostic Imaging and Intervention Section, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Kanjanavanich Road, Hat Yai, Songkla, 90110, Thailand
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Grösslinger K, Lorinson D, Hittmair K, Konar M, Weissenböck H. Iliopsoas abscess with iliac and femoral vein thrombosis in an adult Siberian husky. J Small Anim Pract 2004; 45:113-6. [PMID: 14984156 DOI: 10.1111/j.1748-5827.2004.tb00213.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A nine-year-old, male Siberian husky was presented with fever, decreased appetite and activity, non-weightbearing lameness, and oedematous swelling of the right inguinal and preputial area and the right hindlimb. An abscess within the right iliopsoas muscle, with severe thrombosis of the iliac and femoral vein, was diagnosed by haematology and diagnostic imaging. The abscess and adjoining lymph node were removed surgically through a median coellotomy. The isolated pathogen was Staphylococcus intermedius. Clinical signs resolved completely after surgery. Antimicrobial therapy was continued for four weeks. Within the follow-up period of six months, no recurrence of the clinical signs was detected.
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Affiliation(s)
- K Grösslinger
- Department of Surgery and Ophthalmology, University of Veterinary Medicine, Veterinärplatz 1, A1210 Vienna, Austria
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Maagaard A, Oktedalen O. Psoas abscess diagnosed at a Northern university hospital. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2003; 34:848-51. [PMID: 12578159 DOI: 10.1080/0036554021000026940] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Abscess of the psoas muscle is an infrequent diagnosis at hospitals in Northern countries. We report on 16 patients who had this diagnosis during the period 1991-2001. Eight patients were immigrants who had previously been healthy and most of them had experienced symptoms for approximately 1 y. MRI or CT scans revealed spondylodiscitis in 6 of these patients and Mycobacterium tuberculosis was identified as the causative agent. With the exception of 1 patient who was exclusively treated with antituberculous agents, all 8 immigrant patients were successfully treated with antituberculous agents in addition to percutaneous drainage. The other 8 patients were Norwegians, 4 of whom had underlying conditions such as diabetes mellitus or drug abuse. The causative microorganisms were Staphylococcus aureus or Streptococcus spp., with the exception of M. tuberculosis in 1 case. The Norwegian patients had a more acute history of symptoms than the immigrant patients and 2 of them were in a septic condition on admittance. Two of the Norwegians died of serious infection; 5 were successfully treated with percutaneous drainage in addition to antibiotics and 1 was treated exclusively with antibiotic agents. The clinical history and microorganism associated with psoas abscess seemed to depend on whether or not the patient was an immigrant. Owing to increasing immigration, diagnosis of psoas abscess should be taken into account in Northern countries.
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Affiliation(s)
- Anne Maagaard
- Department of Infectious Diseases, Ullevaal University Hospital, Oslo, Norway.
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