Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2022; 13(4): 381-387
Published online Apr 18, 2022. doi: 10.5312/wjo.v13.i4.381
Minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis
Vasiliki Fesatidou, Evangelos Petsatodis, Dimitrios Kitridis, Panagiotis Givissis, Efthimios Samoladas
Vasiliki Fesatidou, 4th Department of General Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
Evangelos Petsatodis, Department of Interventional Radiology, Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
Dimitrios Kitridis, Panagiotis Givissis, Efthimios Samoladas, 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
Author contributions: Fesatidou V wrote the manuscript; Kitridis D reviewed the manuscript, performed a critical revision, and submitted the manuscript; Petsatodis E acquired and analyzed the data; Samoladas E and Givissis P supervised the study and contributed to patient care.
Institutional review board statement: The study was approved by the Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitrios Kitridis, MD, MSc, Doctor, 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Agiou Dimitriou St, Thessaloniki 54124, Greece. dkitridis@gmail.com
Received: May 17, 2021
Peer-review started: May 17, 2021
First decision: July 6, 2021
Revised: July 29, 2021
Accepted: March 4, 2022
Article in press: March 4, 2022
Published online: April 18, 2022
Processing time: 329 Days and 13.2 Hours
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.

Keywords: Iliopsoas abscess; Spondylodiscitis; Percutaneous drainage; Minimally invasive; Outpatient; Immunocompromised

Core Tip: Eight patients diagnosed with spondylodiscitis complicated with iliopsoas muscle abscess were managed with minimally invasive percutaneous computed tomography-guided drainage, placement of a drain, and proper antibiotic treatment in an outpatient setting. Complete recession of the symptoms with no recurrence after 6 mo was observed. The minimally invasive outpatient management of iliopsoas muscle abscess is a safe and effective approach with a high success rate and low morbidity.