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Study Design: A case of primary Ewing sarcoma of the lumbar spine is presented., Objective: To present and review a rare case of primary Ewing sarcoma of the lumbar spine that required differentiation from spinal infection., Summary of Background Data: Primary Ewing sarcoma originating from the spinal column is very rare. Because Ewing sarcoma is one of the most aggressive bone tumors with high proliferative and invasive potential, its clinical symptoms and variety of imaging manifestations can mimic the pathologic findings of other diseases, including infectious diseases., Methods: The clinical course, radiologic features, pathology and treatment outcome of a patient with primary Ewing sarcoma of the lumbar spine was documented., Results: The magnetic resonance imaging findings showed an abnormal marrow signal at the L2 vertebra and significant enlargement of the unilateral iliopsoas muscle. Immunologic and molecular analysis of the surgical specimen provided a diagnosis of Ewing sarcoma. Laminotomy followed by multidisciplinary therapy including chemotherapy and radiation therapy was effective for treating this case., Conclusion: We report a case of Ewing sarcoma that mimicked a psoas abscess secondary to spinal infection. Abnormal magnetic resonance imaging images, as well as a confusing clinical course, made diagnosis difficult. When enlargement of the iliopsoas with a vertebral lesion is detected in a child with low back pain, Ewing sarcoma should be included in the differential diagnosis.

Study Design: A retrospective assessment of 12 patients with pyogenic spondylitis accompanied by iliopsoas abscess treated by continuous irrigation with our new method between March 2003 and July 2005., Objectives: To present our method of treatment and to evaluate outcomes of 12 patients undergoing it., Summary of Background Data: Since patients with pyogenic spondylitis accompanied by iliopsoas abscess who require surgery are often immunocompromised hosts, open surgery may be excessively invasive. A less invasive operative procedure is therefore desirable for them. Percutaneous drainage is often used for secondary iliopsoas abscess due to pyogenic spondylitis. However, some authors have emphasized the importance of spondylitis as the primary source of infection for secondary iliopsoas abscess and have considered it essential to combine abscess drainage with curative treatment of the primary focus of infection., Methods: We describe our treatment, which involves continuous irrigation using a saline infusion tube inserted into the infectious spondylitic disc as the primary lesion and insertion of a drainage tube into the iliopsoas abscess communicating with the primary lesion. Clinical and radiographic assessment of all 12 patients who received this treatment was performed., Results: Ten (83%) of the 12 patients responded well to this treatment, with clinical results overall. Back pain, a major symptom, was relieved a mean of 9 days after the start of continuous irrigation. The mean duration to remission of C-reactive protein was 30.2 days. Follow-up MRI and CT with enhancement revealed disappearance or near-total resolution of the iliopsoas abscess cavity with healing of pyogenic spondylitis in all 10 patients who responded well to our treatment., Conclusion: This treatment is minimally invasive and useful in carefully selected patients with pyogenic spondylitis complicated by iliopsoas abscess.

Study Design: Clinical and imaging findings of patients diagnosed with pyogenic sacroiliitis were retrospectively analyzed., Objectives: To characterize the clinical and magnetic resonance features of patients with acute pyogenic sacroiliitis without the usually known predisposing conditions and to investigate the diagnostic value of magnetic resonance imaging in detecting the early stages of pyogenic sacroiliitis., Summary of Background Data: Pyogenic sacroiliitis is relatively uncommon, and accurate diagnosis is frequently delayed due to lack of awareness by clinicians and nonspecific clinical presentation. There have been few reports that have evaluated the clinical features of acute pyogenic sacroiliitis and investigated the diagnostic capabilities of magnetic resonance imaging in detecting pyogenic sacroiliitis in the early stages., Methods: The clinical data of 9 patients (6 male, 3 female; average age 27.3 years) diagnosed with acute pyogenic infection of the sacroiliac joint were retrospectively analyzed. Magnetic resonance images as well as computed tomography of the sacroiliac joints were available in all cases. Seven of the patients underwent 99mtechnetium bone scans., Results: All patients showed positive findings on magnetic resonance images, whereas 99mtechnetium bone scans were positive in six of seven patients. Eight patients responded well to treatment with intravenous antibiotic therapy, whereas one patient required debridement of the sacroiliac joint following conservative treatment., Conclusions: Both magnetic resonance imaging and technetium bone scanning are sensitive for localizing occult sites of bone inflammation. Magnetic resonance imaging may provide more useful information than bone scanning by screening for abnormalities in the sacroiliac joint region. With prompt appropriate antibiotic therapy, clinical improvement of patients can be expected.

Study Design: Case report, literature review, discussion., Objectives: To emphasize the role of the spine as primary source of infection for psoas abscess., Summary of Background Data: Spine-associated psoas abscesses increase with more frequent invasive procedures of the spine and recurring tuberculosis in industrialized countries. Diagnosis is often delayed by misinterpretation as arthritis, joint infection, or urologic or abdominal disorders., Methods: We present six cases of psoas abscesses associated with spinal infections that were treated in our hospital from January to December 2001. Diagnostic and treatment concepts are discussed., Results: Our data emphasize the importance of the spine as primary source of infection and suggest an increase in the incidence of secondary psoas abscess. Treatment includes open surgical drainage and antibiotic therapy. In patients with high operative risk and uniloculated abscess, a CT-guided percutaneous abscess drainage can be sufficient. It is essential to combine abscess drainage with causative treatment of the primary infectious focus. Related to the spine, this includes treatment of spondylodiscitis or implant infection after spinal surgery. Usually, several operations are necessary to eradicate bone and soft-tissue infection and restore spinal stability. Continuous antibiotic therapy over a period of 2-3 weeks after normalization of infectious parameters is recommended., Conclusion: The spine as primary source of infection for secondary psoas abscess should always be included in differential diagnosis. Because the prognosis of psoas abscess can be improved by early diagnosis and prompt onset of therapy, it needs to be considered in patients with infection and back or hip pain or history of spinal surgery.

Study Design: This study reports on an extremely rare case of tuberculous psoas abscess and describes the mode of diagnosis and treatment., Objective: This patient is presented to emphasize that cases of solitary psoas abscess resulting from tuberculosis exist today., Summary of Background Data: No recent cases of latent solitary tuberculous psoas abscess have been reported, to the authors' knowledge., Methods: A tuberculous psoas abscess associated with fistula to the greater trochanter may remain dormant for years after tuberculous spondylitis has healed, as a distinct entity without concomitant active bone infection. In our 58-year-old female patient, the diagnosis of a psoas abscess was greatly aided by the "three pass" technetium bone scan and computed tomography, but the anamnesis also was important., Results: Anti-tuberculosis medication (streptomycin, aminosalicylic, and isoniazid) combined with open drainage, curettage of the psoas, and simultaneous revision of the fistula eradicated the disease, making the course of the disease uneventful until the 5-year follow-up evaluation., Conclusions: Orthopedic surgeons must be aware of the rare, delayed appearance of a solitary psoas abscess after tuberculous spondylitis.

Study Design: A case of multiple psoas abscesses after Dove lumbar spine fixation is reported., Objectives: To review the diagnosis and treatment of deep infection after internal spinal fixation., Methods: The possibility of septic complications after spinal surgery that may present with a degenerative pattern is examined. The clinical and computed tomographic findings of a psoas abscess are recalled., Results: Surgical drainage of the purulent collection was performed along with prolonged parenteral antibiotic treatment., Conclusion: Infection should be considered as a cause of recurrence of pain after internal fixation of the lumbar spine.

This case is presented to emphasize that late infection should be considered in all postoperative patients as a cause of pain. A psoas abscess may remain dormant for many years after an anterior spinal procedure. It should be considered in the differential diagnosis of back pain and lumbar radiculopathy after anterior spinal fusion. The lumbar nerve plexus lies within the psoas muscle, and referred pain patterns may occur in the lumbar nerve distribution. In this case, dysesthesias occurred in the distribution of the genitofemoral nerve. The diagnosis and treatment of a psoas abscess has been greatly aided by use of CT and ultrasound. Either of these modalities may be used for directed percutaneous drainage of the abscess. The presence of metal fixation devices necessitates removal of the hardware in order to ensure eradication of the infection.