Abstract
BackgroundMinimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy.MethodsA total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI).ResultsThe mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination.ConclusionMIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
Highlights
Invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST)
The most common symptom of ST was back pain, which was observed in all 106 patients preoperatively
Statistical analysis demonstrated a significant difference in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels preoperatively and at 8 weeks postoperatively (P < 0.05) (Fig. 6)
Summary
Invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy. Tb, which is mentioned in the historical literature, is caused by Mycobacterium tuberculosis, remains an immense public health concern both in China and globally [2]. Psoas or paravertebral abscesses (PAs), which were first reported by Mynter in 1881 [5], is a common complication associated with ST [6]. The objective of treatment for PA with thoracolumbar or lumbar TB is the complete drainage of abscess with regular anti-TB chemotherapy.
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