A case report of percutaneous endoscopic debridement for treating lumbar tuberculous spondylitis with large psoas abscess

• Published in: International journal of surgery case reports 2022-04, Vol.93, p.106850-106850, Article 106850
• Main Authors: Mahadhipta, Harmantya, Ajiantoro, Shihab, Reza Abidin, Saleh, Riky Febriansyah, Tobing, Jephtah Furano Lumban, Gatam, Luthfi, Husin, Syafruddin, Phedy, Gatam, Asrafi Rizki
• Format: Article
• Language: English
• Subjects: Case Report; Percutaneous endoscopic debridement, case report; Psoas abscess; Spondylitis; Tuberculosis
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.106850

Spondylitis tuberculosis is a spinal infection characterized by bone destruction, fracture, abscess, and resulting in deformity (kyphosis and gibbus formation). Therefore, early diagnosis and management of spondylitis tuberculosis have special importance in preventing complications. Surgery is reserved for progressive deformity or where the neurological deficit is not improved by anti-tubercular treatment. The spine can be approached anteriorly or posteriorly in a minimally invasive way. We reviewed the evaluation of clinical outcome, laboratory findings, and radiological post-minimal invasive endoscopic debridement in spinal tuberculosis with psoas abscess. We collected data from two patients, a 24 years-old female and 27 years-old male, who was diagnosed with spondylitis tuberculosis with psoas abscess based on the history, physical, and supportive examination. Patients were given chemotherapy antituberculosis agents and performed percutaneous endoscopic debridement. The outcome was measured by clinical signs, laboratory findings, and radiology evaluation. Patients had pre-operative symptoms of unremitting lower back and thigh pain, febrile sensation, signs of paravertebral muscle tenderness, and limitation of spine motion. Post percutaneous endoscopic debridement, patients showed good response with clinical improvement seen from significant reduction of pain, paravertebral muscle tenderness, increasing spinal motion, laboratory improvement with a decline of ESR and CRP value, and radiology findings improvement with resorption of psoas abscess. No complications were found. Treatment of spondylitis tuberculosis remains controversial regarding optimal use of antituberculosis drugs and the approach used for surgical decompression. Patients had immediate pain relief and reduced disability in treating spinal tuberculosis after percutaneous endoscopic debridement. •Early diagnosis and management of spondylitis tuberculosis have special importance in preventing complications•We reviewed the evaluation of clinical outcome, laboratory findings, and radiological post-minimal invasive endoscopic debridement in spinal tuberculosis with psoas abscess•Post percutaneous endoscopic debridement, patients had a good response in eradicating germs with clinical, laboratory, and radiology findings improvement with resorption of psoas abscess•This study is concerned that a combination of the administration of anti-tuberculous drugs and surgical treatment is the best choice fo