Surgical management of tuberculous iliopsoas cold abscess

Abstract

Purpose

Spinal involvement in tuberculosis is unusual and often involves adjacent structures including the iliopsoas muscle. Very few reports have examined the outcomes of medical and surgical management of spinal tuberculosis with extended iliopsoas abscess (IPA). Accordingly, we present our experiences in the management of spinal tuberculosis with extended iliopsoas abscess (IPA).

Methods

We performed a retrospective review of 29 patients, seen between January 2005 and December 2014, who underwent a combination of medical and surgical treatment for spinal tuberculosis complicated by iliopsoas abscess. Clinical presentation, radiographic parameters, treatment modalities, and outcomes were analyzed.

Results

The average age at time of surgery was 35.9±15.1 years and 60% of patients were male. The most common clinical presentation was back pain although three patients also presented with neurological deficits. Twenty out of 29 lumbar IPA patients underwent surgical treatment for drainage, including 90% by anterior approach, 10% by posterior approach,. In combination with surgery, pharmacotherapy was maintained for a mean duration of 14.6 months. All patients recovered without recurrence. There were no complications except wound dehiscence which were occurred in 60% of patients.

Conclusions

Despite recent advances in percutaneous techniques and materials, there is a subgroup of patients for which surgery with proper pharmacotherapy remains the best treatment option. Careful patient selection, a multidisciplinary approach, and standardized surgical techniques can lead to excellent results without serious complications.