Surgical management of psoas abscess in the Human Immunodeficiency Virus era

Aboobakar, Raza; Cheddie, Shalen; Singh, Bhugwan

doi:10.1016/j.asjsur.2016.10.003

Cited by 9 publications

(25 citation statements)

References 8 publications

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“…In the case of spondylodiscitis with psoas abscesses, percutaneous abscess drainage is an adjunct to conservative treatment, since drainage placement relieves the focus of infection. Success rates of up to 87.5% are described for ultrasound-guided percutaneous drainage placement or CT-guided drainage placement (25,26).…”

Section: Signs Of Paravertebral/epidural Inflammationmentioning

confidence: 99%

Spondylodiscitis: Diagnosis and Treatment Options

Herren

Jung

Pishnamaz

et al. 2017

Deutsches Ärzteblatt International

136

161

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Section: Signs Of Paravertebral/epidural Inflammationmentioning

confidence: 99%

Spondylodiscitis: Diagnosis and Treatment Options

Herren

Jung

Pishnamaz

et al. 2017

Deutsches Ärzteblatt International

136

161

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“…But surgical treatment is still recommended for patients with neurological impairment, conservative treatment failure, spinal instability, huge paravertebral abscess or epidural abscess, and severe pain. Spinal instability includes segmental kyphosis > 15°, vertebral collapse > 50%, and displacement > 5mm [8].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is required when neurological dysfunction, conservative treatment failure, spinal instability (spinal instability includes segmental kyphosis > 15°, vertebral collapse > 50%, and displacement > 5mm. ), huge paravertebral abscess or epidural abscess, and severe pain occur [8]. In Group NVO, 2 cases were treated with antibiotics only, the other 2 cases were treated with posterior debridement and catheter drainage, 23 cases (6 cases in anterior approach and 17 cases in posterior approach) were treated with debridement, fusion and internal fixation, and 3 cases (2 cases in anterior approach and 1 case in posterior approach) were treated with debridement and bone graft fusion; in Group PVO, 13 patients underwent posterior debridement and catheter drainage, 1 patient underwent posterior debridement, fusion and internal fixation, and 3 patients (1 anterior and 2 posterior) underwent debridement and bone graft fusion; ( Tab 2 ) in Group NVO, 1 patient had recurrent infection, so lesion removal and implant removal were performed; 5 patients in Group PVO underwent lesion removal and implant removal ( Table 2).The removed lesion tissues were sent for pathological examination, bacterial culture and drug sensitivity tests.…”

Section: Preoperative Managementmentioning

confidence: 99%

Comparison Between Pyogenic Postoperative and Native Vertebral Osteomyelitis : Clinical Features, Curative Effect and Analysis of Prognostic Factors

abudurexiti

Maimaiti

Maierdan

et al. 2021

Preprint

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BackgroundPyogenic spondylodiscitis(PS) is a potentially life-threatening infection burdened with high morbidity rates. Despite the rising incidence, the proper diagnosis and treatment of PS are still controversial. Postoperative Vertebral Osteomyelitis(PVO) is a clinical challenge, for there were few reports about the treatment results of PVO before, and further more few studies have compared PVO with native vertebral osteomyelitis(NVO). The purpose of this study was to compare and describe the microbiology, clinical characteristics, treatment and curative effect between PVO and NVO, and analyze the prognostic factors as well. MethodsThe clinical data of 52 patients with pyogenic spondylitis admitted to the Spine Surgery Department of the First Affiliated Hospital of Xinjiang Medical University from January 2010 to December 2019 were retrospectively analyzed. There were 30 patients in native vertebral osteomyelitis (NVO) group, including 18 males and 12 females, with an average age of 50.47 ± 20.45 years old (aged from 15 to 73); 22 patients in postoperative vertebral osteomyelitis (PVO) group, including 13 males and 9 females, with an average age of 51.45 ± 16.97 years old (aged from 14 to 73). In Group NVO, 23 cases (76.7%) were located in lumbar vertebrae, 5 cases (16.7%) in thoracic vertebrae and 2 cases (6.7%) in cervical vertebrae; in Group PVO, 16 cases (72.7%) in lumbar vertebrae and 6 cases (27.3%) in thoracic vertebrae. 29 patients had had neurological dysfunction before surgery was taken. There were 26 cases of grade D (16 cases in Group NVO and 10 cases in Group PVO) and 3 cases of grade C (1 case in Group NVO and 2 cases in Group PVO), following the instructions of American Spinal Injury Association (Asia) neurological function classification. All patients were given bed rest, nutritional support and antibiotic therapy; surgical treatment for patients with poor outcomes or aggravated symptoms. Patients were followed up at 1, 3, 6 and 12 months after surgery, including leukocyte count, ESR and CRP, X-ray, CT three-dimensional reconstruction and MRI were performed. The changes of visual analogue scale (VAS) and Asia neurological function classification were observed to evaluate the clinical efficacy simultaneously. ResultsAll patients were followed up for 12-24 months. Till the last follow-up, 3 patients in Group NVO recurred, the recurrence rate was 10% (3 / 30), 9 patients in Group PVO recurred, the recurrence rate was 40.1% (9 / 22), the recurrence rate of Group PVO was higher than that of Group NVO, the difference was statistically significant (P = 0.009). Both groups were treated with intravenous and oral antibiotics, and the time of antibiotic treatment in Group PVO was longer than that in Group NVO, however the difference was not statistically significant (P = 0.094, P = 0.062). Among 44 patients with spinal internal fixation, 13.6% (1 NVO, 5 PVO) had recurrent infection after internal fixation. Therefore, we took re-operation to remove the internal fixator for infection control, patients recovered after conservative treatment such as immobilization and systemic anti infection. The numerical value of leukocytes, C-reactive protein, ESR and VAS scores of the two groups were significantly lower than those before surgery, the difference was statistically significant (P < 0.001). In Group NVO, 16 cases recovered from Asia grade D to grade E, 1 case from grade C to grade D; 10 cases in Group PVO recovered from grade D to grade E and 2 cases recovered from grade C to grade D. There was no significant difference between these two groups (P > 0.05). By univariate analysis, multiple vertebral involvement and abscess formation (P = 0.003, P = 0.025) were significantly associated with PS recurrence; there was a tendency for PS recurrence among microbial infection (OR = 1.889), spinal prosthesis (OR = 7.083) and allogenic bone (OR = 2.032), yet not obvious. By multivariate analysis, we found that multiple vertebral involvement (OR= 12.656, 95% CI: 1.536-104.303, P = 0.018) was a risk factor for PS recurrence. ConclusionThe treatment of PVO is more challenging than NVO, especially in the cases of spinal implant infection. Although the antibiotic treatment time of PVO is longer than that of NVO, the recurrence rate of PVO is higher. Longer antibiotic therapy and, if necessary, surgical debridement or removal of implants are important approaches to successful treatment of PVO.

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“…Secondary psoas abscesses are more common, particularly in developed countries and affect the elderly more often. [4][5][6][7][8][9][10]Through the surgical management (drainage) is simple and often successful, complications such as avascular necrosis of the femoral head, osteomyelitis, cellulitis of the thigh, and septic arthritis of the hip may arise. Other complications may include iliac vein thrombosis, pulmonary embolism, hydronephrosis, renal failure and further dissemination of organisms especially in immunocompromised patients.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Surgical Treatment Outcome of Psoas Muscle Abscess

Khatoon

Shaikh

Memon

et al. 2021

JPRI

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Background: Psoas abscess is a rare condition but one with potential for severe morbidity. Many factors may be implicated in the treatment outcome of the condition and efforts must be directed to identify, understand and control the factors for a better prognosis. Objective: To identify the factors associated with surgical treatment outcome of psoas muscle abscess. Methodology: This descriptive cross-sectional study was conducted upon a sample of 58 patients (chosen via non-probability, consecutive sampling) scheduled for surgical treatment for psoas muscle abscess (aged 18 to 60 years) at department of General Surgery at Liaquat University Hospital, Hyderabad & Jamshoro. All the patients underwent surgical treatment. The data was recorded via pre-structured questionnaire comprising of inquiries pertaining to socio-demographic details, presenting complaints, and factors association with surgical treatment outcome (in terms of resolution of abscess cavity). Data was analyzed via SPSS version 20. Results: Mean age of study subjects was 37.6 ± 12.5 years. Out of all 72.4% were males and 27.5% were females. Most common presentation of patients was pain in flanks, followed by fever. The commonest etiological factor was tuberculosis (TB) and consequently spinal (TB) was the most common. Resolution of abscess cavity was noted among 77.5% of the cases with a greater proportion of recovery falling in line non- tuberculous etiology. Conclusions: After careful consideration, it can be concluded that secondary psoas muscle and that with tuberculous etiology have a poorer surgical outcome, thus greater care and more effective surgical techniques may be employed to achieve complete resolution of abscess.

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Surgical management of psoas abscess in the Human Immunodeficiency Virus era

Cited by 9 publications

References 8 publications

Spondylodiscitis: Diagnosis and Treatment Options

Spondylodiscitis: Diagnosis and Treatment Options

Comparison Between Pyogenic Postoperative and Native Vertebral Osteomyelitis : Clinical Features, Curative Effect and Analysis of Prognostic Factors

Factors Associated with Surgical Treatment Outcome of Psoas Muscle Abscess

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