Iida Keiichiro, Yoshikane Koichi, Tono Osamu, Tarukado Kiyoshi, Harimaya Katsumi
Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumibaru, Beppu, Oita, 874-0838, Japan.
Department of Orthopaedic Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan.
J Med Case Rep. 2019 Aug 15;13(1):253. doi: 10.1186/s13256-019-2193-6.
Psoas or epidural abscesses are often accompanied by pyogenic spondylitis and require drainage. Posterolateral percutaneous endoscopic techniques are usually used for hernia discectomy, but this approach is also useful in some cases of psoas or lumbar ventral epidural abscess. We here report a case of psoas and epidural abscesses accompanied by pyogenic spondylitis that was successfully treated by percutaneous endoscopic drainage.
Our patient was a 57-year-old Japanese woman who had been receiving chemotherapy for inflammatory breast cancer and who became unable to walk due to lower back and left leg pain. She was transported as an emergency to another hospital. Magnetic resonance imaging revealed psoas and epidural abscesses accompanied by pyogenic spondylitis, and methicillin-resistant Staphylococcus aureus was detected in a blood culture. Drainage of the psoas abscess was performed under echo guidance, but was not effective, and she was transferred to our institution. We performed percutaneous endoscopic drainage for the psoas and epidural abscesses. Immediate pain relief was achieved and the inflammatory reaction subsided after 8 weeks of antibiotic therapy with daptomycin.
Percutaneous endoscopy allowed us to approach the psoas and epidural abscesses directly, enabling the immediate drainage of the abscesses with less burden on the patient.
腰大肌或硬膜外脓肿常伴有化脓性脊柱炎，需要进行引流。后外侧经皮内镜技术通常用于椎间盘切除术，但这种方法在某些腰大肌或腰椎腹侧硬膜外脓肿病例中也很有用。我们在此报告一例伴有化脓性脊柱炎的腰大肌和硬膜外脓肿，经皮内镜引流成功治愈。
我们的患者是一名57岁的日本女性，因炎性乳腺癌正在接受化疗，因腰背部和左腿疼痛而无法行走。她被紧急送往另一家医院。磁共振成像显示腰大肌和硬膜外脓肿伴有化脓性脊柱炎，血培养检测到耐甲氧西林金黄色葡萄球菌。在超声引导下对腰大肌脓肿进行了引流，但效果不佳，随后她被转到我们医院。我们对腰大肌和硬膜外脓肿进行了经皮内镜引流。在使用达托霉素进行8周抗生素治疗后，患者立即疼痛缓解，炎症反应消退。
经皮内镜使我们能够直接处理腰大肌和硬膜外脓肿，能够立即引流脓肿，同时减轻患者负担。
