Minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis

Abstract

BACKGROUND 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. AIM 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. METHODS 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. RESULTS 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. Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis 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. CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.

Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review

“…Only 190 patients had their gender described, and 103 males and 87 females were evaluated at a mean follow-up of 23.5 months. Twelve studies used CT-guided PD [ 21 , 22 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], seven studies used US-guided PD [ 12 , 36 , 37 , 38 , 39 , 40 , 41 ], and two studies used both CT-guided and US-guided PD [ 42 , 43 ] ( Figure 2 ).…”

“…A review of 20 articles found that 12 articles focused on CT-guided PD [ 21 , 22 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. These studies were all retrospective, and a total of 181 patients were included in the analysis.…”

“…These studies were all retrospective, and a total of 181 patients were included in the analysis. Among these articles, six utilized both CT and MRI for diagnosing PMA [ 22 , 27 , 29 , 30 , 32 , 35 ], while four relied solely on CT [ 21 , 28 , 31 , 34 ], and one utilized MRI [ 33 ] ( Figure 3 ).…”

“…Five articles reported a 100% success rate for CT-guided PD [ 22 , 27 , 30 , 32 , 35 ]. CT and MRI were used to diagnose 71 patients in total, who underwent successful CT-guided PD.…”

“…CT and MRI were used to diagnose 71 patients in total, who underwent successful CT-guided PD. Three of these papers [ 22 , 30 , 35 ] reported a mean follow-up time of 18.9 months. Four papers [ 22 , 30 , 32 , 35 ] described 52 patients, 18 of whom had bilateral PMA; the mean patient age was 48.975 years, and 32 male and 20 female patients were included in these studies.…”