cold abscess is seen in tuberculosis spine and it is a favorite question of post graduate examiners. all the sites and the tracking of cold abscess explained in detail

1. Sites and path of cold abscess in
Pott’s spine

2. Any vertebral region
• Just in front of vertebrae (elevating anterior
longitudinal ligament)- prevertebral abscess
• Within vertebral canal (rare)

3. In cervical region
1. Retropharyngeal (cervical prevertebral abscess)
2. Posterior border of sternocleidomastoid (by
tracking laterally behind the pre-vertebral fascia)
3. In mediastinum (as abscess tracks behind the
prevertebral fascia<PF> and with gravity reaches
mediastinum)
4. At the back of neck- along the posterior divisions
of spinal nerves and appear on one side of
midline of back of neck
5. In axilla- pus tracks back under the PF and enters
open mouth of axillary sheath

5. Thoracic region
1. Pre-vertebral in posterior mediastenum
2. Along course of one of the thoracic nerves
(explained later)
3. Tracking down in mediastenum till it finds 3
openings (lateral lumbo-costal arch, medial
lumbocostal arch and median arcuate arch)

6. Along thoracic nerves
1. Along intercostal nerves-
• In the thorax at anterior end of intercostal
space
• In the abdominal wall in rectus sheath
2. Along lateral cutaneous branch of intercostal
nerve (mid axillary line)
3. Into back along medial or lateral branch
posterior division of thoracic nerve (1 and 3
inch from line of spine respectively)

9. Through diaphragmatic openings
• Behind lateral lumbocostal arch- extends
down b/w anterior layer of lumbodorsal fascia
and quadratus lumborum (QL) and remain
here on QL muscle behind kidney or
• extends through one of the nerves which lie
behind the kidney (12th thoracic nerve, ilio-
inguinal or ilio-hypogastric nerve to ant abdo
wall)

10. • Medial lumbocostal arch (open upper end of
psoas sheath) – extends till attachment of
iliopsoas on lesser trochanter into thigh
• Median arcuate ligament- along aorta into
abdomen or one of its braches

12. In the lumbar region
1. Extend along the aorta and any of its branches
eg-
1. ischiorectal fossa(along internal pudendal artery) or
2. buttocks(along superior gluteal artery)
2. Into sheath of psoas or quadratus lumborum
3. Follow course of one of lumbar nerves -in thigh
(along femoral or obturator nerve) or in back
4. Extend b/w flat muscles of abdomen into petit’s
triangle

13. Tract for cold abscess
into petit triangle

14. Lumbar triangles

15. Superior lumbar (Grynfeltt-Lesshaft)
triangle
• medially by the quadratus lumborum muscle,
• laterally by the internal oblique muscle, and
• superiorly by the 12th rib

16. Inferior lumbar (Petit's) triangle
• iliac crest inferiorly and
• the margins of two muscles –
– latissimus dorsi (posteriorly) and
– external abdominal oblique (anteriorly).
• The floor of the inferior lumbar triangle is
the internal abdominal oblique muscle.