Psoas Abscess: The Spine as Primary Infection Source

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

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