Patterns of Abscesses of Soft Tissue in Spinal Tuberculosis: Frequency, Topography and Therapeutic Means of 311 Cases Observed in Abidjan (Ivory Coast)

Abstract

Background: The research of soft tissue abscesses in spinal tuberculosis is important and can help in the diagnosis of certainty. These abscesses also have a prognostic and therapeutic interest. The aim of this study is to determine the frequency, topography and the therapeutic means of the abscesses of soft tissue in spinal tuberculosis. Methodology: This descriptive retrospective study covered 311 cases of patients (167 men and 144 women, age range 4-88 years) with soft tissue abscesses on spinal tuberculosis, detected by imaging. The patients have been selected in the rheumatology department of the University Hospital Center of Cocody in Abidjan from January 2003 to December 2013. We were interested to epidemiological, topographical and therapeutic data. Fishers  exact  test  was  used  to  test  the  significance  of  association  between  different  variables. Level of significance was set at 0.05. Results: The prevalence of abscesses was 72.8% that was 311 cases among these 427 records of spinal tuberculosis collected during the study period. The total number of patients was dominated by men (53.6%) and the average age was 43.1 years. Computed tomography scan was the main diagnostic imaging (97.7%). The topography of soft tissue abscesses was: subcutaneous area (1.2%), paraspinal muscles (95.1%), retro-pharyngeal area (10.6%) and epidural area (19.6%). Osteoarticular lesions associated with abscesses were: Spondylodiscitis (96.1%), spondylitis (2.8%) and zygapophyseal arthritis and osteitis (4.5%). The majority of patients had tuberculosis treatment lasting 12 months: 2 months of the combination Rifampicin-Isoniazid-Pyrazinamide-Ethambutol following by 10 months of Rifampicin-isoniazid. The outcome was favorable marked by the resorption of abscesses and the healing of patients. Conclusion: The soft tissue abscesses are common in spinal tuberculosis in Abidjan. They mostly sit at the paraspinal muscles. Their treatment involves corticosteroid-associated with tuberculosis treatment.