Name of the Procedure:

Incision and Drainage, Open, of Deep Abscess (Subfascial), Posterior Spine; Lumbar, Sacral, or Lumbosacral

Summary

An incision and drainage procedure involves making a surgical cut to drain pus or fluid caused by a deep abscess in the lower back. This helps to relieve pain and prevent further infection.

Purpose

This procedure addresses deep abscesses that form under the fascia in the lumbar, sacral, or lumbosacral regions of the spine. The goal is to alleviate pain, reduce infection, and prevent the abscess from spreading or causing more serious complications.

Indications

• Severe back pain localized to the lumbar, sacral, or lumbosacral area.
• Presence of a palpable mass or swelling in the lower back.
• Symptoms of infection such as redness, warmth, and fever.
• Imaging studies indicating a deep abscess.

Preparation

• Patients are usually instructed to fast for at least 8 hours before the procedure.
• Medication adjustments may be required, particularly for blood thinners.
• Pre-procedure imaging studies such as MRI or CT scans to confirm the abscess location and size.
• Routine blood tests to assess overall health and infection markers.

Procedure Description

1. The patient is positioned lying on their stomach.
2. General or regional anesthesia is administered.
3. The skin over the affected area is cleaned and disinfected.
4. A surgical incision is made in the skin and tissue down to the abscess.
5. The abscess is located, and its contents are drained using surgical instruments.
6. The area is thoroughly cleaned and irrigated.
7. A drain may be placed to allow continuous drainage.
8. The incision is closed using sutures or left open to heal, depending on the surgeon’s assessment.

Duration

The procedure typically takes about 45 minutes to 1 hour.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• A spinal surgeon or orthopedic surgeon will perform the procedure.
• An anesthesiologist will manage the anesthesia.
• Nursing staff will assist during the procedure and in post-operative care.

Risks and Complications

• Infection or re-infection of the abscess.
• Bleeding and hematoma formation.
• Damage to surrounding nerves or tissues.
• Reaction to anesthesia.
• Possible need for additional surgeries.

Benefits

• Relief from pain and discomfort caused by the abscess.
• Reduction in infection and its complications.
• Improved mobility and function of the lower back.

Recovery

• Patients may need to stay in the hospital for a few days for observation and continued drainage.
• Pain medication and antibiotics may be prescribed.
• Instructions for wound care and signs of infection will be given.
• Most patients can resume normal activities within a few weeks, with some restrictions on physical activities.
• Follow-up appointments to monitor healing and ensure the abscess does not recur.

Alternatives

• Antibiotic therapy alone, though often ineffective for deep abscesses.
• Percutaneous (needle) drainage, which may be less invasive but not as effective for large or complex abscesses.
• Pros of the open procedure include thorough drainage and reduced recurrence; cons include higher invasiveness and longer recovery.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel pain.
• Post-procedure discomfort is managed with pain medication.
• Patients may experience soreness and some limitations in movement initially but will improve as healing progresses.
• Careful adherence to post-operative instructions will enhance recovery and minimize complications.