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Al-Khafaji MQ, Al-Smadi MW, Al-Khafaji MQ, Aslan S, Al-Khafaji YQ, Bagossy-Blás P, Al Nasser MH, Horváth BL, Viola Á. Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review. J Clin Med 2024; 13:3199. [PMID: 38892910 PMCID: PMC11173313 DOI: 10.3390/jcm13113199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.
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Affiliation(s)
- Murtadha Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Mohammad Walid Al-Smadi
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mustafa Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Siran Aslan
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
- Doctoral School of Clinical Medicine, Semmelweis University, 1083 Budapest, Hungary
| | - Yousif Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Panna Bagossy-Blás
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mohammad Hakem Al Nasser
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Bálint László Horváth
- Department of Traumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary;
| | - Árpád Viola
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
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Deng F, Chen B, Guo H, Chen Q, Wang F. Effectiveness and safety analysis of titanium mesh grafting versus bone grafting in the treatment of spinal Tuberculosis: a systematic review and meta-analysis. BMC Surg 2023; 23:377. [PMID: 38087216 PMCID: PMC10717474 DOI: 10.1186/s12893-023-02283-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND To systematically assess the safety and effectiveness of titanium mesh grafting compared with bone grafting in the treatment of spinal tuberculosis. METHODS Electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, were searched from their inception until April 2023. The outcome indicators for patients treated with titanium mesh grafting or bone grafting for spinal tuberculosis include surgical duration, intraoperative blood loss, graft fusion time, American Spinal Injury Association (ASIA) Spinal Cord Injury Grade E assessment, VAS score, lumbar pain score, post-graft kyphotic angle, and postoperative complications. The Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used for quality assessment and evidence grading of clinical studies. Funnel plots and Begg's test were employed for bias assessment. RESULTS A total of 8 studies were finally included, comprising 523 patients, with 267 cases of titanium mesh fixation and 256 cases of bone grafting. The meta-analysis showed no significant statistical differences in surgical duration (Weighted Mean Difference (WMD) = -7.20, 95% Confidence Interval (CI): -28.06 to 13.67, P = 0.499), intraoperative blood loss (WMD = 16.22, 95% CI: -40.62 to 73.06, P = 0.576), graft fusion time (WMD = 0.97, 95% CI: -0.88 to 2.81, P = 0.304), ASIA Spinal Cord Injury Grade E assessment (Relative Risk (RR) = 1.03, 95% CI: 0.97 to 1.09, P = 0.346), and overall complications (RR = 0.87, 95% CI: 0.49 to 1.55, P = 0.643). Differences in VAS score, ODI lumbar pain score, and post-graft kyphotic angle between the titanium mesh grafting group and the bone grafting group were not significant within the 95% CI range. The rate of postoperative implant subsidence was slightly lower in bone grafting than in titanium mesh grafting (RR = 9.30, 95% CI: 1.05 to 82.22, P = 0.045). CONCLUSIONS Both bone grafting and titanium mesh grafting are effective and safe for the surgery, with no significant statistical differences in the results. Considering the limitations of the present study, large-scale randomized controlled trials are warranted to further verify the reliability of this finding.
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Affiliation(s)
- Fangfang Deng
- The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang Hubei, 443000, China
| | - Bo Chen
- The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang Hubei, 443000, China
| | - Huali Guo
- The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang Hubei, 443000, China
| | - Qingqing Chen
- The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang Hubei, 443000, China
| | - Feifan Wang
- The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang Hubei, 443000, China.
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Clinical Efficacy of CT-Guided Continuous Catheterization Drainage for Spinal Tuberculosis with Large Abscesses. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2402048. [PMID: 35126912 PMCID: PMC8813261 DOI: 10.1155/2022/2402048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
Objective This study aimed to determine the efficacy of computed tomography (CT)-guided local catheterization for the treatment of spinal tuberculosis (TB) with abscess. Methods Clinical data from 22 cases of lumbar TB with abscess receiving treatments from July 2015 to January 2021 were analyzed. Some patients (n = 11) underwent pure surgery (control group) and the others (n = 11) received CT-guided catheterization drainage. The operation and hospitalization time, erythrocyte sedimentation rate (ESR), visual analog scale (VAS), ASIA damage grade, and C-reactive protein (CRP) levels of both groups were compared. Results The operation time, intraoperative blood loss, and hospital stay of the observation group were significantly less than those of the control group (P < 0.05). As the differences in preoperative ESR, CRP, and VAS scores between both groups did not reach significance (P > 0.05), after treatments, the observation group had a lower level of ESR and CRP (P < 0.05); the postoperative VAS scores of the two groups decreased (P > 0.05). Before treatment, the control group comprised 2 cases of ASIA grade A, 1 case of B, 6 cases of C, and 2 cases of D with 3 patients having dyskinesia. After surgery, the motor function of the patients was improved, and there were 3 cases of ASIA D and 8 cases of E. Meanwhile, the preoperative observation group consisted of 9 cases of ASIA D and 2 cases of E. Due to CT-guided catheterization, all patients achieved clinical healing (ASIA E) when the lesions were significantly alleviated, and symptoms such as low back pain and lower extremity pain disappeared. Conclusion CT-guided percutaneous catheter drainage for continuous administration of drugs is effective treatment for spinal TB with abscess, when shortening the operation and hospitalization time and reducing intraoperative blood loss and erythrocyte sedimentation rate. It is worthy of popularization and application.
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Zhang Z, Hao Y, Wang X, Zheng Z, Zhao X, Wang C, Zhang X, Zhang X. Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis - a long-term retrospective study of 106 cases. BMC Musculoskelet Disord 2020; 21:353. [PMID: 32505204 PMCID: PMC7276089 DOI: 10.1186/s12891-020-03344-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy. Methods A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI). Results The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination. Conclusion MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
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Affiliation(s)
- Zhifa Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Yongyu Hao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xiangyu Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Zhirong Zheng
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xuelin Zhao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Chunguo Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xifeng Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
| | - Xuesong Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
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Liu Z, Zhang P, Li W, Xu Z, Wang X. Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up. J Orthop Surg Res 2020; 15:99. [PMID: 32156304 PMCID: PMC7063822 DOI: 10.1186/s13018-020-01616-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no comparative study with long-term follow-up between posterior-only and combined posterior-anterior approaches in treating lumbar spinal tuberculosis (LSTB) and lumbosacral spinal tuberculosis (LSSTB). This retrospective study aimed to compare and evaluate the long-term outcomes of these two surgical approaches in LSTB and LSSTB. METHODS Thirty patients with LSTB and 12 patients with LSSTB underwent posterior-only approach (group A); 26 patients with LSTB and 14 patients with LSSTB were managed with combined posterior-anterior approaches (group B). Analysis and comparison in clinical and radiographic outcomes between the two groups were performed. RESULTS The intra-operative bleeding amount, surgery time, and hospitalization days in group A were less than that in group B (P < 0.05). These patients were followed for a minimum of 7 years. All patients achieved completely healing within 2-year follow-up. Bony fusion was obtained in all patients. The visual analog scale, Japanese Orthopedic Association score, Oswestry Disability index, and Kirkaldy-Willis functional evaluation at the final visit demonstrated that all patients in both groups achieved satisfactory results. There was no significant difference in angle correction or maintaining correction between combined posterior-anterior approaches and posterior-only approach (P > 0.05). Complications occurred in both groups. CONCLUSIONS Both combined posterior-anterior approaches and posterior-only approach can achieve satisfactory clinical and radiological outcomes of long-term in treating LSTB and LSSTB, while posterior-only approach can safely and effectively achieve lesion debridement, decompression, and stability reconstruction and maintenance with the advantages of less invasive surgery, less bleeding, shorter surgery time, and hospital stay, and fewer complications. So, posterior-only approach seemed to be superior to the combined posterior-anterior one.
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Affiliation(s)
- Zheng Liu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Penghui Zhang
- The Orthopedics Department, the Seventh Affiliated Hospital, Sun Yat-sen University, 628#Zhenyuan Road, Zhenmei Community, Guangming District, Shenzhen, 518107, Guangdong, People's Republic of China
| | - Weiwei Li
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Zhengchao Xu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Xiyang Wang
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China. .,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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