Published online Apr 18, 2022. doi: 10.5312/wjo.v13.i4.381
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
There has been an evolution in the management of complicated spondylodiscitis with iliopsoas muscle abscess (IPA) formation through the years and computed tomography (CT)-guided drain insertion with antibiotic therapy being the current practice.
Complicated spondylodiscitis with IPA formation in immunocompromised patients could be managed in an outpatient setting.
The purpose of the current study was to describe the care management of complicated spondylodiscitis.
A 4-year retrospective collection and analysis of all radiologically diagnosed cases of IPA that were treated with CT-guided percutaneous drainage. Data included patient demographics, underlying conditions, isolated microorganisms, antibiotic regimes used, abscess size, days until the withdrawal of the catheter, and final outcome. All draining procedures were performed by direct insertion of a 12 Fr pigtail catheter into the abscess cavity.
All 8 patients were diagnosed with IPA formation secondary to complicated spondylodiscitis, and two of them were diagnosed with spinal tuberculosis. All 8 patients showed complete recession of the symptoms and radiological findings after the CT-guided abscess drainage and the long-term antibiotic therapy. The microbiology cultures identified Staphylococcus aureus in 3 cases and Mycobacterium tuberculosis in 2 cases and were negative in the remaining 3 cases. There was no need for patient hospitalization.
The minimally invasive outpatient management of IPA, which combines CT-guided percutaneous drainage and placement of a drain with proper antibiotic treatment, proved to be a safe and effective approach with a high success rate and low morbidity.
More studies should be performed in order to prove the cost effectiveness and the decreased morbidity of the minimally invasive outpatient management of these patients.