The preferred surgical approach for drainage of a large psoas abscess tracking from a lumbar Pott's disease to the femoral triangle is:

• A Midline posterior laminectomy and abscess drainage
• B Extraperitoneal anterior approach (retroperitoneal) for debridement and drainage, combined with radical anterior debridement and fusion ✓
• C CT-guided percutaneous aspiration of the psoas component alone
• D Simple incision and drainage at the femoral triangle without spinal surgery

Explanation

A psoas abscess in lumbar TB requires: (1) radical anterior debridement of diseased disc and vertebrae (via retroperitoneal extraperitoneal approach), (2) drainage of the psoas and femoral triangle components, and (3) anterior or posterior instrumented fusion to stabilise the deformity. CT-guided aspiration alone does not address the underlying spinal disease or provide structural stabilisation. Simple femoral triangle drainage without spinal surgery leads to recurrence and progressive kyphosis.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.