To investigate efficacy and feasibility of minimally invasive retroperitoneoscopic surgery (MIS) for psoas abscess (PA) with thoracolumbar tuberculosis.

Since Jan. 2010 to Jan. 2014, retrospectively, 35 patients of the diagnosis of PA with thoracolumbar tuberculosis received the debridement of psoas abscesses and cavity walls of abscesses by the retroperitoneoscopic technique (MIS) in combination with anti-tuberculosis chemotherapy. Inclusion criteria: psoas abscess with thoracolumbar tuberculosis without severe neural deficit and obvious spinal deformity after the total evaluation of X-ray and physical examination. For all the suspected patients preoperatively, the diagnoses of PA associated with tuberculous thoracolumbar spondylitis were made on the evidences of clinical symptoms such as mild fever, night-sweats, weight loss and laboratory examinations as well as examinations such as X-ray, computed tomography (CT), and magnetic resonance imaging (MRI). The diagnoses of tuberculosis-induced PA were confirmed by pathological examination, acid-fast stain and/or culture of mycobacterium tuberculosis. All the patients took at least 2 weeks experimental anti-tuberculosis therapy preoperatively. ESR and x-ray, MRI were examined in the follow-up.

Immediately relief in clinical symptoms and signs and amelioration in imaging and laboratory examinations were obviously observed in all the patients. One week and three months postoperative, ESR was (27.0 ± 11.0)mm/h、(18.0 ± 7.0)mm/h respectively. Statistical analysis demonstrated that there was significant difference between pre- and postoperative ESR [(65.5 ± 30.8)mm/h] (P<0.05). The first patient of MIS in our group had a recurrent abscess in the follow-up of 9 months postoperative due to dissemination of tuberculous abscess. One patients developed a sinus after operation. The follow-up had proceeded for at least 12 months [(21 ± 9)months]. No complication was observed during the follow-up postoperatively.

The retroperitoneoscopic technique for PA gain advantages in terms of shorter hospital stay, minimal invasiveness, recurrent rate compared with percutaneous drainage and anterior or posterior debridement surgery. Despite the technique has not been fully clinically proved, it seems to be a recommended option for the patients without severe deformity and neural system injury as an effective diagnostic and therapeutic technique for PA, especially with massive or complicated PA combined with local and systematic antituberculous chemotherapy.