A case report of percutaneous endoscopic debridement for treating lumbar tuberculous spondylitis with large psoas abscess

Harmantya Mahadhipta; Ajiantoro; Reza Abidin Shihab; Riky Febriansyah Saleh; Jephtah Furano Lumban Tobing; Luthfi Gatam; Syafruddin Husin; Phedy; Asrafi Rizki Gatam

doi:10.1016/j.ijscr.2022.106850

A case report of percutaneous endoscopic debridement for treating lumbar tuberculous spondylitis with large psoas abscess

Int J Surg Case Rep. 2022 Apr:93:106850. doi: 10.1016/j.ijscr.2022.106850. Epub 2022 Feb 25.

Authors

Harmantya Mahadhipta¹, Ajiantoro², Reza Abidin Shihab³, Riky Febriansyah Saleh⁴, Jephtah Furano Lumban Tobing², Luthfi Gatam⁵, Syafruddin Husin⁵, Phedy⁵, Asrafi Rizki Gatam⁵

Affiliations

¹ Head of Orthopaedic Spine Division, Tangerang General Hospital, Faculty of Medicine University of Indonesia, Indonesia; Orthopaedic Spine Division, Gatam Institute Eka Hospital, South Tangerang, Indonesia.
² Orthopaedic Spine Fellowship, Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Indonesia.
³ Orthopaedic Resident, Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Indonesia. Electronic address: reza.abidin91@ui.ac.id.
⁴ Orthopaedic Resident, Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Indonesia.
⁵ Orthopaedic Spine Division, Gatam Institute Eka Hospital, South Tangerang, Indonesia.

Abstract

Introduction and importance: Spondylitis tuberculosis is a spinal infection characterized by bone destruction, fracture, abscess, and resulting in deformity (kyphosis and gibbus formation). Therefore, early diagnosis and management of spondylitis tuberculosis have special importance in preventing complications. Surgery is reserved for progressive deformity or where the neurological deficit is not improved by anti-tubercular treatment. The spine can be approached anteriorly or posteriorly in a minimally invasive way. We reviewed the evaluation of clinical outcome, laboratory findings, and radiological post-minimal invasive endoscopic debridement in spinal tuberculosis with psoas abscess.

Case presentation: We collected data from two patients, a 24 years-old female and 27 years-old male, who was diagnosed with spondylitis tuberculosis with psoas abscess based on the history, physical, and supportive examination. Patients were given chemotherapy antituberculosis agents and performed percutaneous endoscopic debridement. The outcome was measured by clinical signs, laboratory findings, and radiology evaluation.

Discussion: Patients had pre-operative symptoms of unremitting lower back and thigh pain, febrile sensation, signs of paravertebral muscle tenderness, and limitation of spine motion. Post percutaneous endoscopic debridement, patients showed good response with clinical improvement seen from significant reduction of pain, paravertebral muscle tenderness, increasing spinal motion, laboratory improvement with a decline of ESR and CRP value, and radiology findings improvement with resorption of psoas abscess. No complications were found.

Conclusion: Treatment of spondylitis tuberculosis remains controversial regarding optimal use of antituberculosis drugs and the approach used for surgical decompression. Patients had immediate pain relief and reduced disability in treating spinal tuberculosis after percutaneous endoscopic debridement.

Keywords: Percutaneous endoscopic debridement, case report; Psoas abscess; Spondylitis; Tuberculosis.