Fesatidou V, Petsatodis E, Kitridis D, Givissis P, Samoladas E. Minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis. World J Orthop 2022; 13(4): 381-387 [PMID: 35582155 DOI: 10.5312/wjo.v13.i4.381]
Corresponding Author of This Article
Dimitrios Kitridis, MD, MSc, Doctor, 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Agiou Dimitriou St, Thessaloniki 54124, Greece. dkitridis@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Vasiliki Fesatidou, 4th Department of General Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
Evangelos Petsatodis, Department of Interventional Radiology, Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
Dimitrios Kitridis, Panagiotis Givissis, Efthimios Samoladas, 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
Author contributions: Fesatidou V wrote the manuscript; Kitridis D reviewed the manuscript, performed a critical revision, and submitted the manuscript; Petsatodis E acquired and analyzed the data; Samoladas E and Givissis P supervised the study and contributed to patient care.
Institutional review board statement: The study was approved by the Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitrios Kitridis, MD, MSc, Doctor, 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Agiou Dimitriou St, Thessaloniki 54124, Greece. dkitridis@gmail.com
Received: May 17, 2021 Peer-review started: May 17, 2021 First decision: July 6, 2021 Revised: July 29, 2021 Accepted: March 4, 2022 Article in press: March 4, 2022 Published online: April 18, 2022
ARTICLE HIGHLIGHTS
Research background
There has been an evolution in the management of complicated spondylodiscitis with iliopsoas muscle abscess (IPA) formation through the years and computed tomography (CT)-guided drain insertion with antibiotic therapy being the current practice.
Research motivation
Complicated spondylodiscitis with IPA formation in immunocompromised patients could be managed in an outpatient setting.
Research objectives
The purpose of the current study was to describe the care management of complicated spondylodiscitis.
Research methods
A 4-year retrospective collection and analysis of all radiologically diagnosed cases of IPA that were treated with CT-guided percutaneous drainage. Data included patient demographics, underlying conditions, isolated microorganisms, antibiotic regimes used, abscess size, days until the withdrawal of the catheter, and final outcome. All draining procedures were performed by direct insertion of a 12 Fr pigtail catheter into the abscess cavity.
Research results
All 8 patients were diagnosed with IPA formation secondary to complicated spondylodiscitis, and two of them were diagnosed with spinal tuberculosis. All 8 patients showed complete recession of the symptoms and radiological findings after the CT-guided abscess drainage and the long-term antibiotic therapy. The microbiology cultures identified Staphylococcus aureus in 3 cases and Mycobacterium tuberculosis in 2 cases and were negative in the remaining 3 cases. There was no need for patient hospitalization.
Research conclusions
The minimally invasive outpatient management of IPA, which combines CT-guided percutaneous drainage and placement of a drain with proper antibiotic treatment, proved to be a safe and effective approach with a high success rate and low morbidity.
Research perspectives
More studies should be performed in order to prove the cost effectiveness and the decreased morbidity of the minimally invasive outpatient management of these patients.
