Fesatidou Vasiliki, Petsatodis Evangelos, Kitridis Dimitrios, Givissis Panagiotis, Samoladas Efthimios
4Department of General Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece.
Department of Interventional Radiology, Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece.
World J Orthop. 2022 Apr 18;13(4):381-387. doi: 10.5312/wjo.v13.i4.381.
Iliopsoas muscle abscess (IPA) and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management. They are both frequently related to underlying conditions, such as immunosuppression, and in many cases they are combined. IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process, including spondylodiscitis. Computed tomography-guided percutaneous drainage has been established in the current management of this condition.
To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.
Patient demographics, clinical presentation, underlying conditions, isolated microorganisms, antibiotic regimes used, abscess size, days until the withdrawal of the catheter, and final treatment outcomes were recorded and analyzed.
All patients presented with night back pain and local stiffness with no fever. The laboratory tests revealed elevated inflammatory markers. Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases. was isolated in 3 patients and in 2 patients. Negative cultures were found in the remaining 3 patients. The treatment protocol included percutaneous computed tomography-guided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy. All procedures were done in an outpatient setting with no need for patient hospitalization.
The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.
髂腰肌脓肿（IPA）和脊椎椎间盘炎是两种临床病症，通常表现不典型且治疗具有挑战性。它们都常与潜在疾病相关，如免疫抑制，并且在许多情况下两者并存。IPA可能是微生物经血行播散至肌肉导致的原发性脓肿，也可能是炎症过程（包括脊椎椎间盘炎）直接蔓延引起的继发性脓肿。计算机断层扫描引导下经皮引流已成为目前治疗这种病症的方法。
对8例免疫功能低下且患有脊椎椎间盘炎合并IPA的患者进行回顾性分析，这些患者在门诊接受了计算机断层扫描引导下经皮引流及引流管置入治疗。
记录并分析患者的人口统计学资料、临床表现、潜在疾病、分离出的微生物、使用的抗生素方案、脓肿大小、引流管拔除天数以及最终治疗结果。
所有患者均表现为夜间背痛和局部僵硬，无发热。实验室检查显示炎症标志物升高。所有病例均有脊椎椎间盘炎伴单侧或双侧IPA的影像学表现。3例患者分离出[具体微生物名称未给出]，2例患者分离出[具体微生物名称未给出]。其余3例患者培养结果为阴性。治疗方案包括计算机断层扫描引导下经皮脓肿引流及引流管置入，同时进行针对性或经验性抗生素治疗。所有操作均在门诊进行，无需患者住院。
IPA的微创门诊治疗是一种安全有效的方法，成功率高且发病率低。
