Percutaneous management of complications of tuberculous spondylodiscitis: short- to medium-term results.
ABSTRACT Psoas abscesses are the most frequent complication of tuberculosis with skeletal involvement. The aim of this paper is to report our experience with the systematic application of percutaneous drainage to tuberculous psoas abscesses.
Between January 1997 and December 2005, 23 patients (14 men and nine women; age range 21-48 years), after a previous study with computed tomography (CT) and/or magnetic resonance (MR) imaging, underwent percutaneous drainage of a tuberculous fluid collection in the psoas muscles. Follow-up consisted of monthly clinical and laboratory assessment, and plain chest radiography and spinal CT every 6-12 months.
Spondylodiscitis involved the thoracolumbar spine. Fluid collections were bilateral in 14 cases and communicating in ten of these. Maximum transverse diameter was 7 cm, whereas longitudinal diameter was 14 cm. Placement of the drainage catheter was successful in all cases, and the catheter was left in place for 5-36 (mean 18.4) days. Symptom regression occurred immediately after drainage of the fluid collection. The drainage procedure was curative in 100% of cases. Dislodgement of the drainage catheter occurred in two cases as a result of excessive traction during dressing removal.
A serious complication of bone tuberculosis, psoas abscesses, can be effectively treated by percutaneous drainage, leading to immediate pain resolution. The drainage catheter requires daily monitoring to identify when it can be safely removed without risk of recurrence.
- SourceAvailable from: Giuseppe Kenneth Ricciardi[show abstract] [hide abstract]
ABSTRACT: Spinal infections typically involve vertebrae as well as discs, and for this reason they are called septic spondylodiscitis. Magnetic resonance imaging is the most sensitive imaging method for the evaluation of this group of spinal diseases. The use of contrast-enhanced T1-weighted sequences with fat suppression, if correctly applied, may increase information provided by MRI. Firstly, this technique allows the primary vertebral focus, which often precedes disc involvement, to be identified at a very early stage. When the disease spreads, T1-weighted fat-suppressed gadolinium dimeglumine (Gd-DTPA) enhanced images provide macroscopic details of the primary vertebral focus, disc involvement patterns, and pathways of infection diffusion. All this information, when correlated with laboratory tests, may be useful in identifying the infectious agents (tuberculous vs piogenic forms), thus enabling a suitable therapy to be started. This technique is also useful in the assessment of the real extension of the disease, providing a clear depiction of paravertebral space involvement and of psoas muscle abscesses. Dangerous complications, such as meningitis, myelitis, and epidural abscesses, may be more promptly diagnosed and fully evaluated with fat-suppressed post-contrast T1-weighted images. Finally, this imaging technique may help to differentiate infectious processes from degenerative disorders, extradural neoplastic processes, and rheumatic diseases.European Radiology 04/2003; 13(3):626-37. · 3.55 Impact Factor
Article: Infections of the Spine[show abstract] [hide abstract]
ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.Contemporary Spine Surgery. 09/2008; 9(10):1–5.
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ABSTRACT: To evaluate midterm results of percutaneous drainage (PD) with image guidance in 21 patients with tuberculous iliopsoas abscesses with or without spondylodiskitis. Computed tomography (CT)-guided PD was performed in 21 patients with 26 tuberculous iliopsoas abscesses. Nineteen patients had bone involvement of two or more vertebrae. Eleven patients with spondylodiskitis had intradiskal abscesses. Five patients had bilateral psoas abscesses. Easily and safely accessible well-circumscribed abscesses larger than 3 cm were selected for PD. Catheters were inserted into the abscess cavities with Seldinger technique in all cases. In conjunction with PD, all patients had antituberculous drug therapy and underwent clinical and imaging follow-up for at least 1 year. Percutaneous catheter placement was successful in all cases without procedural complications. On the basis of CT findings, complete evacuation of all abscesses was achieved initially. During follow-up, six (29%) of 21 patients had recurrences within 1 and 3 months after catheter removal. A total of 37 catheters were used; eight of the 37 catheters were inserted due to recurrences. Four patients needed two PD procedures, and two patients needed three due to recurrences. Four catheters were changed because of obstruction or dislocation. Drainage duration ranged from 5 to 36 days (mean, 14.9 days). The follow-up period was 12-52 months (mean, 24 months). None of the patients, including those with recurrence, required surgical drainage and débridement due to insufficient PD. Image-guided PD in conjunction with antituberculous drug therapy is an effective and safe procedure in the treatment of tuberculous iliopsoas abscesses with or without spondylodiskitis.Radiology 12/2002; 225(2):353-8. · 6.34 Impact Factor