[Mini-invasive treatment of purulent spondylitis associated with a psoas abscess in a child (case report)].

: The authors describe a case of a 12 years old boy who suffered from pain in the lumbar region, limitation of dynamics in lumbosacral spine with a gradual deterioration of the condition. The patient was afebrile. The pain was getting worse and the classic radiographs did not show at the beginning any pathological changes. Suspected were mainly the discogenic syndrome, functional vertebrogenous syndrome but also development of a tumour in the region of spine. CT scan revealed structural changes in the region of L3 vertebra and less in the L4 region. At the same time it showed a soft mass pushing the psoas muscle to the left which was described as paravertebral abscess and the structural changes as a suspect L3, L4 spondylitis. The condition of the patient was associated with a high risk of endocarditis as in the childhood he underwent the Senning operation for coarctation of great vessels. Therefore it was necessary to determine etiological agent as quickly as possible. After a mini-invasive surgery with a probational biopsy and subsequent drainage the spondylytis was confirmed also histologically and a coagulation-negative Staphylococcus aureus was cultivated as an etiological agent. At the same time tumour development was eliminated. After 15 weeks the antibiotic therapy was changed as after the removal of drains the microbe was already resistant to the administered antibiotics and therefore the antibiotics were changed with regard to sensitivity and minimum inhibition concentrations. Within 15 weeks after a local drainage by antibiotics and the total antibiotic therapy also inflammation markers gradually decreased and the patient is for a long period without complaints with full range of motion in the lumbosacral spine. In the conclusion the authors emphasize the accurate timing algorithm of the diagnosis in children which may initiate an early and successful treatment.