title: Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique.
abstract: BACKGROUND
  Percutaneous aspiration of abscesses under ultrasonography (USG) and computer tomography (CT) scan has been well described. With recurrence rate reported as high as 66%. The open drainage and percutaneous continuous drainage (PCD) has reduced the recurrence rate. The disadvantage of PCD under CT is radiation hazard and problems of asepsis. Hence a technique of clinically guided percutaneous continuous drainage of the psoas abscess without real-time imaging overcomes these problems. We describe clinically guided PCD of psoas abscess and its outcome.
  
  
  METHODS
  Twenty-nine patients with dorsolumbar spondylodiscitis without gross neural deficit with psoas abscess of size >5 cm were selected for PCD. It was done as a day care procedure under local anesthesia. Sequentially, aspiration followed by guide pin-guided trocar and catheter insertion was done without image guidance. Culture sensitivity was done and chemotherapy initiated and catheter kept till the drainage was <10 ml for 48 hours. Outcome assessment was done with relief of pain, successful abscess drainage and ODI (Oswestry Disability Index) score at 2 years.
  
  
  RESULTS
  PCD was successful in all cases. Back and radicular pain improved in all cases. Average procedure time was 24.30 minutes, drain output was 234.40 ml, and the drainage duration was 7.90 days. One patient required surgical stabilisation due to progression of the spondylodiscitis resulting in instability inspite of successful drainage of abscess. Problems with the procedure were noticed in six patients. Multiple attempts (n = 2), persistent discharge (n = 1) for 2 weeks, blocked catheter (n = 2) and catheter pull out (n = 1) occurred with no effect on the outcome. The average ODI score improved from 62.47 to 5.51 at 2 years.
  
  
  CONCLUSIONS
  Clinically guided PCD is an efficient, safe and easy procedure in drainage of psoas abscess.
authors.affiliation: Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
authors.forename: Bharat R
authors.initials: BR
authors.lastname: Dave
authors.affiliation: Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
authors.forename: Ranganatha Babu
authors.initials: RB
authors.lastname: Kurupati
authors.affiliation: Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
authors.forename: Dipak
authors.initials: D
authors.lastname: Shah
authors.affiliation: Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
authors.forename: Devanand
authors.initials: D
authors.lastname: Degulamadi
authors.affiliation: Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
authors.forename: Nitu
authors.initials: N
authors.lastname: Borgohain
authors.affiliation: Department of Orthopaedics, Stavya Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Krishnan
keywords: Abscess; percutaneous continuous drainage; psoas; spondylodiscitis; tuberculosis