La gestione percutanea delle complicanze della spondilodiscite tubercolare: risultati nel breve-medio periodo

Pieri, Stefano; Agresti, Paolo; Altieri, A; Ialongo, Pasquale; Cortese, Antonio; Alma, Mario Giuseppe; Medici, Lorenzo

doi:10.1007/s11547-009-0425-3

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…As to vertebral instability and progressive deformity, percutaneous pedicle screw fixation should be performed to prevent vertebral collapse and kyphotic deformity. In the presence of extensive PA, PCD [34][35][36][37][38][39][40][41] or retroperitoneoscopic drainage [19,27,28] are the recommended treatments.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis — a long-term retrospective study of 106 cases

Zhang

Hao

Wang

et al. 2020

BMC Musculoskelet Disord

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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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Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis — a long-term retrospective study of 106 cases

Zhang

Hao

Wang

et al. 2020

BMC Musculoskelet Disord

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“…Sacroiliac joint tuberculosis accounts for approximately 10 % of skeletal tuberculosis cases [5, 13, 28]. The formation of paraspinal tuberculous abscesses is seen in 50 to 75 % of spinal tuberculosis cases [7, 18, 26]. Kim [17] and Gao [11] reported similar results in that almost 50 % of patients with sacroiliac joint tuberculosis had gluteal and inguinal abscesses.…”

Section: Introductionmentioning

confidence: 97%

The efficacy of negative pressure wound therapy in treating sacroiliac joint tuberculosis with a chronic sinus tract: a case series

Luo

Tang

et al. 2015

J Orthop Surg Res

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ObjectiveTuberculous sacroiliitis with abscess accounts for approximately 50 % of all sacroiliac joint tuberculosis cases. Tuberculous abscesses spread into the sacroiliac joint capsule, subcutaneous tissue, and the skin, and finally becomes a skin sinus. As there are no previous reports about sacroiliac joint tuberculosis with a chronic sinus, we evaluated its clinical characteristics and management by negative pressure wound therapy.MethodsA retrospective analysis of 12 patients with sacroiliac joint tuberculosis with chronic sinuses treated between January 2005 and January 2010 was conducted. Patients were treated with negative pressure wound therapy (NPWT). Treatment was divided into three phases: control phase, standard dressing changes daily for 4 weeks; interphase washout period, dressing changes every 3 days for 1 week; and intervention phase, no dressing changes until minimal sinus tract drainage (<5 ml per 24 h). Outcomes including the sinus healing time and the drainage volume were evaluated.ResultsThe mean follow-up was 37.1 months. Sinus healing was observed at an average of 25.25 ± 7.23 (range, 20–42) days after initial treatment. The mean volume of drainage did not change during the control phase, but decreased from 29.17 ± 16.63 to 0.25 ± 0.87 ml in the intervention phase. The mean daily reduction of wound volume, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the intervention phase was greater than in the control phase (P < 0.05). Anti-tubercular therapy was administered an average of 14.00 ± 2.95 (range, 12–18) months. ESR and CRP returned to normal within 3 months after the sinus closure. Bony fusion was observed in 5 (41.7 %) patients, and fibrous ankylosis in the other patients at last follow-up. All patients healed uneventfully.ConclusionsEarly diagnosis of sacroiliac joint tuberculosis with a chronic sinus can be difficult. NPWT provides better healing of sacroiliac joint tuberculosis with a chronic sinus than standard dressing changes.

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“…Abscesses under pressure benefit from the immediate decompression provided through drainage 456. This was very evident with the significant and quick improvement in low back pain ( n = 29) and radicular pain ( n = 6).…”

Section: Discussionmentioning

confidence: 96%

“…There are reports of the abscess getting resolved with chemotherapy alone 34. The advocates of surgery recommend that once pus is drained the throbbing pain alleviates because the pressure within the cavity reduces and symptoms relieve immediately 56. Conventionally, surgical treatment of abscess has been open drainage through the Pettit's triangle or the Poupart's ligament 7.…”

Section: Introductionmentioning

confidence: 99%

Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique

Dave

Kurupati

Shah

et al. 2014

IJOO

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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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La gestione percutanea delle complicanze della spondilodiscite tubercolare: risultati nel breve-medio periodo

Abstract: A serious complication of bone tuberculosis, psoas abscesses, can be effectively treated by percutaneous drainage, leading to immediate pain resolution. The drainage catheter requires daily monitoring to identify when it can be safely removed without risk of recurrence.

Cited by 12 publications

References 21 publications

Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis — a long-term retrospective study of 106 cases

Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis — a long-term retrospective study of 106 cases

The efficacy of negative pressure wound therapy in treating sacroiliac joint tuberculosis with a chronic sinus tract: a case series

Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique

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