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Spinal cord abscess

Alternative names

Abscess - spinal cord

Definition

Spinal cord abscess is a disorder characterized by inflammation and a collection of infected material (pus) around the spinal cord.

Causes, incidence, and risk factors

A spinal cord abscess is caused when infection occurs within the internal areas of the spine. An abscess of the spinal cord itself is very, very rare. A spinal abscess usually occurs as an epidural abscess .

Pus forms as a collection of fluid, destroyed tissue cells, white blood cells, and live and dead microorganisms. The pus commonly becomes encapsulated (enclosed) by a lining or membrane that forms around the edges. The pus collection ( abscess ) causes pressure on the spinal cord. The infection may cause inflammation and swelling , which also compresses the spinal cord.

The infection is usually bacterial, often a result of staphylococcus infection that spreads through the bones and membranes of the spine. In some rare cases, the infection may be fungal or viral. Tuberculosis is a cause of spinal cord abscess that is less common than in the past but still occurs in some areas of the world.

The risks include boils (furuncles) on the skin, particularly on the back or scalp. Abscess may also result from the spread of any infection through the bloodstream from another body location ( bacteremia ). Back injuries or trauma, including minor injuries, increase the risk of spinal cord abscess. Occasionally, spinal cord abscess may be a complication of lumbar puncture (spinal tap) or surgery on the back.

The initial infection often begins in the bone ( osteomyelitis ). The bone infection may trigger formation of an epidural abscess which enlarges and rapidly compresses the spinal cord, causing symptoms similar to those caused by exterior sources of spinal cord trauma .

The disorder is rare, but may be life-threatening.

Symptoms

fever
chills
backache in the lower back
- often mild
- progressively worsening
- typically radiating to hip, leg, or feet
- may radiate to the shoulder, arm, or hand
sudden or rapid progression of neurologic symptoms
loss of movement of an area of the body
weakness or paralysis
loss of sensation of an area of the body
numbness in a specific, limited area (localized)
loss of bladder or bowel control
- inability to retain feces ( fecal incontinence )
- unable to keep from leaking urine ( urinary incontinence )
male impotence

Signs and tests

An examination often shows localized tenderness over the spine. A neurologic examination may indicate spinal cord compression , with involvement of the lower body (paraplegia) or the entire trunk, arms, and legs (quadriplegia). The extent of neurologic losses corresponds with the location of the lesion on the spine and with the amount of spinal cord compression.

A CSF examination may be normal or may contain a few white blood cells and slightly elevated protein levels.
A CT scan or MRI confirm epidural abscess. Dye may be necessary for CT scan to show a clear picture of the abscess.
A culture of material obtained by surgical drainage of the abscess will determine the specific microorganism(s) responsible for the infection.

Treatment

The goals of treatment are to relieve spinal cord compression and cure the infection.

Urgent surgical decompression (by laminectomy, cutting through the bones of the spine) is sometimes recommended, depending on the condition of the patient. This procedure involves draining of the abscess. It occasionally is not possible to completely drain the abscess.

Antimicrobial medications are prescribed. Broad-spectrum antimicrobials or a combination of antibiotics are the most commonly used antimicrobials. Antimicrobial medications may be adjusted after a culture of pus determines the specific microorganism causing the infection.

Corticosteroids may occasionally be prescribed to reduce swelling and compression of the spinal cord.

Expectations (prognosis)

An untreated spinal cord abscess progresses to spinal cord compression that causes permanent, severe paralysis and other neurologic losses. It may be life-threatening.

The outcome for a treated spinal cord abscess may vary. There may be a complete recovery. A recurrence of an abscess is possible. Incomplete drainage may result in a recurrence of an abscess or development of a chronic fibrotic (scarred) mass (aggregation of cells) in the spinal cord.

Complications

recurrence of spinal cord abscess
formation of fibrous spinal cord mass
spinal cord compression, life threatening
permanent neurologic losses (variable)
- weakness, paralysis
- loss of sensation
- loss of bladder/bowel control
- male impotence
- other losses

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if symptoms of spinal cord abscess occur. This is usually an emergency condition!

Prevention

Thorough treatment of such as boils, tuberculosis, and others, decreases the risk.

People with endocarditis or congenital heart disorders may be advised to receive prophylactic (preventive) treatment with antibiotics prior to dental or oral (by mouth) procedures.

Update Date: 11/18/2003

D. Scott Smith, MD, MSc, DTM&H, Infectious Diseases Division and Dept. of Microbiology and Immunology, Stanford University Medical School, Stanford, CA. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT
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