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

Publication Date:
24 September 2003 (online)

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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.

Key words

Psoas abscess - spinal infection

References

  • 1 Altemeier W A, Alexander J W. Retroperitoneal abscess.  Arch Surg. 1961;  83 512-524
    PubMedGoogle Scholar
  • 2 Babafemi T. Psoas abscess: a primer for the internist.  Southern Med J. 2001;  94 2-5
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 4 Buchholz S, Marti D, Schulthess G. et al . Tuberkulöser Psoasabszess.  Dtsch Med Wschr. 2000;  125 866-868
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 Desandre A R, Cottone F J, Evers M L. Iliopsoas abscess: etiology, diagnosis and treatment.  Am Surg. 1995;  61 1087-1091
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 10 Gruenwald I, Abrahamson J, Cohen O. Psoas abscess: case report and review of the literature.  J Urol. 1992;  147 1624-1626
    PubMedGoogle Scholar
  • 11 Hresko M T, Hall J E. Latent psoas abscess after anterior spinal fusion.  Spine. 1992;  17 590-593
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 15 Lee J KT, Glazer H S. Psoas muscle disorders: MR imaging.  Radiology. 1986;  160 683-687
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 20 Procaccino J A, Lavery I C, Fazio V W. et al . Psoas abscess: difficulties encountered.  Dis Colon Rectum. 1991;  34 784-789
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 22 Ricci M A, Meyer K K. Psoas abscess complicating Crohn's disease.  Am J Gastroenterol. 1985;  80 970-977
    PubMedGoogle Scholar
  • 23 Ricci M A, Rose F B, Meyer K K. Pyogenic psoas abscess: worldwide variations in etiology.  World J Surg. 1986;  10 834-843
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 25 Thomas E, Leroux J L, Segnarbieux F. et al . Multiple psoas abscess after posterior spinal fusion.  Spine. 1995;  20 373-374
    PubMedGoogle Scholar

Tanja Schütz M. D. 

Berufsgenossenschaftliche Unfallklinik Murnau

Prof.-Küntscher-Str. 8

82418 Murnau

Germany

Phone: +49/88 41/48 25 72

Fax: +49/88 41/48 21 70

Email: tanja_schuetz@hotmail.com

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