Management of spinal epidural abscess complicating psoas abscess: A retrospective study of 30 patients

Psoas abscess is a quite rare clinical condition. Its extension to the spinal epidural space and formation of spinal epidural abscess (SEA) is another rare perilous complication which may result in significant neurological deficits. In this study, we report our experience with management of psoas abscess associated with SEA. This retrospective study included 30 patients with SEA complicating psoas abscess. Detailed imaging studies were done using plain X-ray, computed tomography and magnetic resonance imaging with contrast for spinal and paraspinal regions. Patients were managed medically or surgically using transabdominal psoas abscess evacuation, decompression surgery or both. On discharge, patients were classified to have good or poor outcome. Patients were followed for 1 year after discharge. A total of 30 patients with combined psoas abscess and SEA were included. Radiological studies identified bilateral psoas abscess in 7 patients (23.3%). Lumbar region was the most common location of SEA (66.7%). Cord compression signs were detected in 10 patients (33.3%). Surgically, transabdominal psoas abscess evacuation was used in 20 patients (66.7%) while decompression surgery was used in 4 patients (13.3%) and combined approach was used in 6 patients (20.0%). On discharge, good outcome was achieved in 29 patients (96.7%). No complications or recurrence were observed during 1-year follow up period. Management of SEA complicating psoas abscess using medical treatment or surgical intervention using transabdominal psoas abscess evacuation, decompression surgery or both is safe and effective with no complications over 1-year follow up period.