Osteosynthesis and Trauma Care 2003; 11: 141-145
DOI: 10.1055/s-2003-42316
Varia

© Georg Thieme Verlag Stuttgart · New York

Psoas Abscess: The Spine as Primary Infection Source

T. Schütz1 , T. Mückley1 , G. Hofmann1 , M. Potulski1 , V. Bühren1
  • 1Trauma Center Murnau, Murnau, Germany
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
24. September 2003 (online)

Abstract

Spine associated psoas abscesses increase with more frequent invasive procedures of the spine and reoccuring tuberculosis in industrialized countries. Diagnosis is often delayed by misinterpretation as arthritis, joint infection, urologic or abdominal disorders.
We present six cases of psoas abscesses associated with spinal infections, that were treated in our hospital from January - December 2001. Our data emphasize the spine as primary infection source and suggest an increase in the incidence of secondary psoas abscess. Treatment includes open surgical drainage and antibiotic therapy. In patients with high operative risk and uniloculated abscess, a CT-guided percutaneous abscess drainage can be sufficient. It is essential to combine abscess drainage with causative treatment of the primary infectious focus. Related to the spine, this includes treatment of spondylodiscits or implant infection after spinal surgery. Usually several operations are necessary to eradicate bone and soft tissue infection and restore spinal stability.
Due to frequent delays in diagnosis and late onset of therapy, the mortality rates of psoas abscess is high. However with prompt therapeutic intervention, the prognosis is good. Therefore, psoas abscess should be a diagnosis considered in patients with infection and back or hip pain or history of spinal surgery.

References

  • 1 Altemeier W A, Alexander J W. Retroperitoneal abscess.  Arch Surg. 1961;  83 512-524
  • 2 Babafemi T. Psoas abscess: a primer for the internist.  Southern Med J. 2001;  94 2-5
  • 3 Bartolo D DC, Ebbs S R, Cooper M J. Psoas abscess in Bristol: A 10-year review.  Int J Colorect Dis. 1987;  1 72-76
  • 4 Buchholz S, Marti D, Schulthess G. et al . Tuberkulöser Psoasabszess.  Dtsch Med Wschr. 2000;  125 866-868
  • 5 Chern C H, Hu S C, Kao W F. et al . Psoas abscess: making an early diagnosis in the ED.  Am J Emerg Med. 1997;  15 83-88
  • 6 Desandre A R, Cottone F J, Evers M L. Iliopsoas abscess: etiology, diagnosis and treatment.  Am Surg. 1995;  61 1087-1091
  • 7 Finnerty R U, Vordermark J S, Modarelli R O. et al . Primary psoas abscess: case report and review of literature.  J Urol. 1981;  126 108-109
  • 8 Franco-Paredes C, Blumberg H M. Psoas muscle abscess caused by Mycobacterium tuberculosis and Staphylococcus aureus: case report and review.  Am J Med Sci. 2001;  321 415-417
  • 9 Gordin F, Stamler C, Mills J. Pyogenic psoas abscess: noninvasive diagnostic techniques and review of the literature.  Rev Infect Dis. 1983;  5 1003-1011
  • 10 Gruenwald I, Abrahamson J, Cohen O. Psoas abscess: case report and review of the literature.  J Urol. 1992;  147 1624-1626
  • 11 Hresko M T, Hall J E. Latent psoas abscess after anterior spinal fusion.  Spine. 1992;  17 590-593
  • 12 Kao P F, Tsui K H, Leu H S, Tsai M F, Tzen K Y. Diagnosis and treatment of pyogenic psoas abscess in diabetic patients: usefulness of computed tomography and gallium-67 scanning.  Urology. 2001;  57 246-251
  • 13 Korovessis P, Papadaki E, Repanti M. et al . Latent solitary tuberculous psoas abscess 52 years after healed thoracolumbar tuberculous spondylitis.  Spine. 1995;  20 1709-1712
  • 14 Korovessis P, Petsinis G, Papazisis Z. Unilateral psoas abscess following posterior transpedicular stabilization of the lumbar spine.  Eur Spine J. 2000;  9 588-590
  • 15 Lee J KT, Glazer H S. Psoas muscle disorders: MR imaging.  Radiology. 1986;  160 683-687
  • 16 Leu S Y, Leonard M B, Beart R W. et al . Psoas abscess: changing patterns of diagnosis and etiology.  Dis Colon Rectum. 1986;  29 694-698
  • 17 Nussbaum E S, Rockswold G L, Bergman T A. et al . Spinal tuberculosis: a diagnostic and management challenge.  J Neurosurg. 1997;  83 243-247
  • 18 Perry J, Barrack R L, Burke S W. et al . Psoas abscess mimicking a septic hip.  J Bone Joint Surg Am. 1985;  67 1281-1283
  • 19 Phillips K, Husni M E, Karlson E W, Coblyn J S. Experience with etanercept in an academic medical center: are infection rates increased?.  Arthritis Rheum. 2002;  47 17-21
  • 20 Procaccino J A, Lavery I C, Fazio V W. et al . Psoas abscess: difficulties encountered.  Dis Colon Rectum. 1991;  34 784-789
  • 21 Redondo C C, Zarranz J E, Toves A R, Sesmero J A, Simal F, Sagarra J MM. Traitement de l'abcès du psoas: drainage percutané ou chirurgie ouverte.  Progrès en Urologie. 2000;  10 418-423
  • 22 Ricci M A, Meyer K K. Psoas abscess complicating Crohn's disease.  Am J Gastroenterol. 1985;  80 970-977
  • 23 Ricci M A, Rose F B, Meyer K K. Pyogenic psoas abscess: worldwide variations in etiology.  World J Surg. 1986;  10 834-843
  • 24 Santaella R O, Fishman E K, Lipsett P A. Primary vs secondary iliopsoas abscess: presentation, microbiology and treatment.  Arch Surg. 1995;  130 1309-1313
  • 25 Thomas E, Leroux J L, Segnarbieux F. et al . Multiple psoas abscess after posterior spinal fusion.  Spine. 1995;  20 373-374

Tanja Schütz M. D. 

Berufsgenossenschaftliche Unfallklinik Murnau

Prof.-Küntscher-Str. 8

82418 Murnau

Germany

Telefon: +49/88 41/48 25 72

Fax: +49/88 41/48 21 70

eMail: tanja_schuetz@hotmail.com