Percutaneous management of complications of tuberculous spondylodiscitis: short- to medium-term results. Radiol Med

Radiologia Vascolare ed Interventistica, Rome, Italy.
La radiologia medica (Impact Factor: 1.34). 07/2009; 114(6):984-95. DOI: 10.1007/s11547-009-0425-3
Source: PubMed


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.

17 Reads
    • "There are reports of the abscess getting resolved with chemotherapy alone.34 The advocates of surgery recommend that once pus is drained the throbbing pain alleviates because the pressure within the cavity reduces and symptoms relieve immediately.56 Conventionally, surgical treatment of abscess has been open drainage through the Pettit's triangle or the Poupart's ligament.7 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Percutaneous aspiration of abscesses under ultrasonography (USG) and computer tomography (CT) scan has been well described. With recurrence rate reported as high as 66%. The open drainage and percutaneous continuous drainage (PCD) has reduced the recurrence rate. The disadvantage of PCD under CT is radiation hazard and problems of asepsis. Hence a technique of clinically guided percutaneous continuous drainage of the psoas abscess without real-time imaging overcomes these problems. We describe clinically guided PCD of psoas abscess and its outcome. Twenty-nine patients with dorsolumbar spondylodiscitis without gross neural deficit with psoas abscess of size >5 cm were selected for PCD. It was done as a day care procedure under local anesthesia. Sequentially, aspiration followed by guide pin-guided trocar and catheter insertion was done without image guidance. Culture sensitivity was done and chemotherapy initiated and catheter kept till the drainage was <10 ml for 48 hours. Outcome assessment was done with relief of pain, successful abscess drainage and ODI (Oswestry Disability Index) score at 2 years. PCD was successful in all cases. Back and radicular pain improved in all cases. Average procedure time was 24.30 minutes, drain output was 234.40 ml, and the drainage duration was 7.90 days. One patient required surgical stabilisation due to progression of the spondylodiscitis resulting in instability inspite of successful drainage of abscess. Problems with the procedure were noticed in six patients. Multiple attempts (n = 2), persistent discharge (n = 1) for 2 weeks, blocked catheter (n = 2) and catheter pull out (n = 1) occurred with no effect on the outcome. The average ODI score improved from 62.47 to 5.51 at 2 years. Clinically guided PCD is an efficient, safe and easy procedure in drainage of psoas abscess.
    No preview · Article · Mar 2014 · Indian Journal of Orthopaedics
  • [Show abstract] [Hide abstract]
    ABSTRACT: Transient neonatal pustular melanosis is mostly found in full-term black infants. It is a benign and self-limited disease, and the etiology is still unknown. We present a full-term female neonate with multiple vesiculopustular and pigmented macular lesions found immediately after her birth. A skin biopsy showed vesicles consisting of intracorneal and subcorneal aggregates of neutrophils, which is compatible with transient neonatal pustular melanosis. Although it is rare in Taiwan and Asian countries, transient neonatal pustular melanosis should always be considered when pustulosis is found in the neonatal period to prevent the use of unnecessary antibiotics. Dermatological consultation and histological confirmation are sometimes required for the final diagnosis.
    No preview · Article · Dec 2010 · Pediatrics & Neonatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although an ancient disease, tuberculosis is still a major public health problem that affects both developing and developed countries. With the increase in immuno-compromised states, it has become a larger problem which is growing ever-more-difficult to treat. The most common site of extrapulmonary tuberculosis is the spine, and here it causes destruction and deformity which may lead to kyphosis and paraplegia. The natural history of tuberculous spondylitis has been defined in great detail owing to its frequency in the years preceding the advent of anti-tuberculous drugs and effective surgical treatment options. Today the treatment of spinal tuberculosis begins with diagnosis, which can be still be difficult. This includes a careful history, physical examination, x-rays and, most importantly, MRI scans However, often, tissue diagnosis is necessary and cultures, though generally reliable, are often slow to yield results. Surgical treatment can commence after obtaining tissue for diagnosis and addresses removal of necrotic tissue at the affected segments, instability and, if it already exists, deformity. The use of implants in tuberculous spondylitis has been shown to be safe, and necessary in specific cases owing to unacceptable kyphosis as an outcome after exclusively conservative treatment. Today, the preferred form of treatment is debridement and instrumented fusion, and depending on the stability of fixation, post-operative immobilization. The mainstay of treatment, as it was 50 years ago, is still anti-tuberculous medical therapy.
    No preview · Chapter · Jan 2011
Show more