A comparative study to evaluate the feasibility of preoperative percutaneous catheter drainage for the treatment of lumbar spinal tuberculosis with psoas abscess

Abstract

Background: Spinal tuberculosis is a frequent cause of psoas abscess (PA), and PA largely negates the efficacy of antituberculosis therapy. This study aimed to investigate the clinical outcome of preoperative percutaneous catheter drainage (PCD) in patients with lumbar spinal tuberculosis and PA.

Methods: Between January 2015 and January 2017, 72 patients with lumbar spinal tuberculosis with PA were assigned to group A (preoperative PCD) and group B (n = 36 per group). All patients received posterior pedicle screw fixation and anterior focal debridement and fusion. Data on intraoperative blood loss, the duration of the surgery, and the length of the anterior incision were recorded, as well as the postoperative anal exhaust time, visual analogue scale (VAS), Cobb angle, lumbar vertebra function, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and sinus tract formation.

Results: Sixty-eight patients were followed up for an average time of 13 months (range 6-21 months). Until the final follow-up, no mixed infections, recurrence of tuberculosis, pedicle screw loosening, or screw pullout had occurred. There were significant between-group differences in blood loss, surgery duration, anterior incisional length, postoperative anal exhaust time, and sinus tract formation. As compared with group B, the ESR and CRP levels of the patients in group A were markedly improved following 3 weeks of antituberculosis therapy and 1 week postsurgery.

Conclusion: Preoperative PCD helps to increase the efficacy of antituberculosis therapy prior to surgery, reduce surgical trauma, and avoid postoperative complications, making it a safe and feasible treatment option for lumbar spinal tuberculosis with PA.

Keywords: Catheter drainage; Lumbar vertebra; Psoas abscess; Spine; Tuberculosis.

Fig. 1

A 46-year-old female patient with tuberculosis of the L1/2 lumbar vertebrae and PA underwent preoperative PCD under ultrasound guidance, antituberculosis therapy for 3 weeks, posterior pedicle screw fixation, and anterior debridement and bone graft fusion. a. Preoperative magnetic resonance imaging (MRI) showing lumbar spinal tuberculosis, with abscess formation. b–e. PCD was performed under ultrasound guidance. f, g. The X-ray image 3 days after surgery showed good internal fixation and bone grafting. h. Postoperative MRI performed at the 3-month follow-up showed complete debridement and no obvious abscess

Fig. 2

A 39-year-old male patient with tuberculosis of the L1/2 lumbar vertebrae and PA underwent posterior pedicle screw fixation and anterior debridement, with bone graft fusion. a. Preoperative MRI showed lumbar tuberculosis, with abscess formation. b, c. The X-ray image 3 days after surgery showed good internal fixation and bone grafting. d. Postoperative MRI at the 3-month follow-up showed complete debridement and no obvious abscess