Name of the Procedure:

Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or cervicothoracic

Summary

This procedure involves making an incision to drain a deep abscess located under the fascia (a layer of connective tissue) in the posterior (back) region of the cervical (neck), thoracic (mid-back), or cervicothoracic (combined neck and upper back) spine.

Purpose

The procedure is performed to treat deep abscesses that cause significant pain, swelling, or infection in the back. The primary goal is to eliminate the collection of pus and reduce the infection, which helps alleviate symptoms and prevent the spread of infection to other areas.

Indications

• Severe back pain, swelling, and redness
• Fever and other signs of systemic infection
• Presence of a deep abscess confirmed via imaging studies (e.g., MRI or CT scan)
• Failure of conservative treatments like antibiotics

Preparation

• The patient may be instructed to fast for several hours before the procedure.
• Medications, especially blood thinners, may need adjustment.
• Diagnostic tests such as blood work and imaging studies are completed to locate the abscess.

Procedure Description

1. The patient is positioned to allow the best access to the affected area.
2. General anesthesia or regional anesthesia is administered to ensure the patient is comfortable and pain-free.
3. The surgeon makes an incision over the affected area to access the deep abscess.
4. The abscess is drained using surgical tools, and any infected tissue is removed.
5. The area is thoroughly cleaned and irrigated to minimize infection.
6. Depending on the case, a drain may be placed to allow further drainage of fluids.
7. The incision is closed with sutures or staples.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and size of the abscess.

Setting

The procedure is conducted in a hospital setting, often in an operating room equipped for spinal surgery.

Personnel

• Surgeon (typically a spinal or general surgeon)
• Anesthesiologist
• Surgical nurses
• Scrub techs for instrument handling

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Damage to surrounding tissues, nerves, or blood vessels
• Potential for recurrence of the abscess
• Rare risks include adverse reactions to anesthesia

Benefits

• Relief from pain and discomfort caused by the abscess
• Reduction in infection and prevention of its spread
• Improved mobility and function of the back, neck, or both

Recovery

• Post-procedure, the patient may need to stay in the hospital for monitoring.
• Pain management through prescribed medications.
• Instructions on wound care and keeping the area clean to prevent infection.
• Follow-up appointments to monitor recovery and remove any surgical drains.
• Patients can expect a recovery period of a few weeks, depending on the severity of the abscess and their overall health.

Alternatives

• Antibiotic treatment (typically tried before considering surgical intervention)
• Needle aspiration (less invasive but might not be as effective for deep abscesses)
• Observation and symptomatic treatment, though not advisable for severe abscesses

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel pain.
• Post-procedure, there may be some discomfort or pain at the incision site, which can be managed with medications.
• The patient might experience some restrictions on activities to promote healing and will receive specific instructions on exercises, physical therapy, and follow-up care.