Study design: A retrospective assessment of 12 patients with pyogenic spondylitis accompanied by iliopsoas abscess treated by continuous irrigation with our new method between March 2003 and July 2005.
Objectives: To present our method of treatment and to evaluate outcomes of 12 patients undergoing it.
Summary of background data: Since patients with pyogenic spondylitis accompanied by iliopsoas abscess who require surgery are often immunocompromised hosts, open surgery may be excessively invasive. A less invasive operative procedure is therefore desirable for them. Percutaneous drainage is often used for secondary iliopsoas abscess due to pyogenic spondylitis. However, some authors have emphasized the importance of spondylitis as the primary source of infection for secondary iliopsoas abscess and have considered it essential to combine abscess drainage with curative treatment of the primary focus of infection.
Methods: We describe our treatment, which involves continuous irrigation using a saline infusion tube inserted into the infectious spondylitic disc as the primary lesion and insertion of a drainage tube into the iliopsoas abscess communicating with the primary lesion. Clinical and radiographic assessment of all 12 patients who received this treatment was performed.
Results: Ten (83%) of the 12 patients responded well to this treatment, with clinical results overall. Back pain, a major symptom, was relieved a mean of 9 days after the start of continuous irrigation. The mean duration to remission of C-reactive protein was 30.2 days. Follow-up MRI and CT with enhancement revealed disappearance or near-total resolution of the iliopsoas abscess cavity with healing of pyogenic spondylitis in all 10 patients who responded well to our treatment.
Conclusion: This treatment is minimally invasive and useful in carefully selected patients with pyogenic spondylitis complicated by iliopsoas abscess.