Clinical efficacy of CT-guided percutaneous huge ilio-psoas abscesses drainage combined with posterior approach surgery for the management of dorsal and lumbar spinal tuberculosis in adults

BMC Musculoskelet Disord

Hao

Wang

et al. 2020

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.

Section: The Principals Of Mismentioning

confidence: 99%

Section: The Principals Of Mismentioning

confidence: 99%

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

BMC Musculoskelet Disord

Hao

Wang

et al. 2020

“…Wu et al also noted that local chemotherapy has lower recurrence rate and greater effectiveness [ 4 ]. In a study of Zou et al, 16 patients underwent two-stage CT-guided percutaneous abscess drainage and posterior debridement, decompression, intervertebral fusion, and device treatment; the neurological deficits were recovered to varying degrees with significantly improved patients' life quality [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy of CT-Guided Continuous Catheterization Drainage for Spinal Tuberculosis with Large Abscesses

Journal of Healthcare Engineering

Liang

et al. 2022

Objective. This study aimed to determine the efficacy of computed tomography (CT)-guided local catheterization for the treatment of spinal tuberculosis (TB) with abscess. Methods. Clinical data from 22 cases of lumbar TB with abscess receiving treatments from July 2015 to January 2021 were analyzed. Some patients (n = 11) underwent pure surgery (control group) and the others (n = 11) received CT-guided catheterization drainage. The operation and hospitalization time, erythrocyte sedimentation rate (ESR), visual analog scale (VAS), ASIA damage grade, and C-reactive protein (CRP) levels of both groups were compared. Results. The operation time, intraoperative blood loss, and hospital stay of the observation group were significantly less than those of the control group P < 0.05 . As the differences in preoperative ESR, CRP, and VAS scores between both groups did not reach significance P > 0.05 , after treatments, the observation group had a lower level of ESR and CRP P < 0.05 ; the postoperative VAS scores of the two groups decreased P > 0.05 . Before treatment, the control group comprised 2 cases of ASIA grade A, 1 case of B, 6 cases of C, and 2 cases of D with 3 patients having dyskinesia. After surgery, the motor function of the patients was improved, and there were 3 cases of ASIA D and 8 cases of E. Meanwhile, the preoperative observation group consisted of 9 cases of ASIA D and 2 cases of E. Due to CT-guided catheterization, all patients achieved clinical healing (ASIA E) when the lesions were significantly alleviated, and symptoms such as low back pain and lower extremity pain disappeared. Conclusion. CT-guided percutaneous catheter drainage for continuous administration of drugs is effective treatment for spinal TB with abscess, when shortening the operation and hospitalization time and reducing intraoperative blood loss and erythrocyte sedimentation rate. It is worthy of popularization and application.

“…In recent years, CT-guided percutaneous abscesses drainage and focal catheter infusion have been introduced as a new approach in the management of STB abscesses [36,37]. In this study, a case with postoperative abscess formation in group A was successfully treated via this method, which may be a safe and effective way in adjuvant therapy combined with posterior approach [38,39]. Moreover, for cases with severe destruction of three or more vertebral bodies due to difficult reconstruction of the spinal anterior column, combined anterior-posterior approaches were superior to posterior-only approach.…”

Section: Discussionmentioning

confidence: 99%

Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up

Liu

et al. 2020

J Orthop Surg Res

Background: There is no comparative study with long-term follow-up between posterior-only and combined posterioranterior approaches in treating lumbar spinal tuberculosis (LSTB) and lumbosacral spinal tuberculosis (LSSTB). This retrospective study aimed to compare and evaluate the long-term outcomes of these two surgical approaches in LSTB and LSSTB. Methods: Thirty patients with LSTB and 12 patients with LSSTB underwent posterior-only approach (group A); 26 patients with LSTB and 14 patients with LSSTB were managed with combined posterior-anterior approaches (group B). Analysis and comparison in clinical and radiographic outcomes between the two groups were performed. Results: The intra-operative bleeding amount, surgery time, and hospitalization days in group A were less than that in group B (P < 0.05). These patients were followed for a minimum of 7 years. All patients achieved completely healing within 2-year follow-up. Bony fusion was obtained in all patients. The visual analog scale, Japanese Orthopedic Association score, Oswestry Disability index, and Kirkaldy-Willis functional evaluation at the final visit demonstrated that all patients in both groups achieved satisfactory results. There was no significant difference in angle correction or maintaining correction between combined posterior-anterior approaches and posterior-only approach (P > 0.05). Complications occurred in both groups. Conclusions: Both combined posterior-anterior approaches and posterior-only approach can achieve satisfactory clinical and radiological outcomes of long-term in treating LSTB and LSSTB, while posterior-only approach can safely and effectively achieve lesion debridement, decompression, and stability reconstruction and maintenance with the advantages of less invasive surgery, less bleeding, shorter surgery time, and hospital stay, and fewer complications. So, posterior-only approach seemed to be superior to the combined posterior-anterior one.