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Spinal cord abscess

Definition

Spinal cord abscess is swelling and irritation (inflammation) and the collection of infected material (pus) around the spinal cord.

Alternative Names

Abscess - spinal cord

Causes, incidence, and risk factors

A spinal cord abscess is caused by an infection inside the spine. An abscess of the spinal cord itself is very rare. A spinal abscess usually occurs as an epidural abscess.

Pus forms as a collection of:

• Destroyed tissue cells
• Fluid
• Live and dead bacteria and other microorganisms
• White blood cells

The pus is commonly covered by a lining or membrane that forms around the edges. The pus collection causes pressure on the spinal cord.

The infection is usually due to bacteria. Often it is caused by a staphylococcus infection that spreads through the spine. It may be caused by tuberculosis in some areas of the world, but it is not as common today as it was in the past. In rare cases, the infection may be due to a fungus.

The following increase your risk of a spinal cord abscess:

• Back injuries or trauma, including minor ones
• Boils on the skin, especially on the back or scalp
• Complication of lumbar puncture or back surgery
• Spread of any infection through the bloodstream from another part of the body (bacteremia)

The infection often begins in the bone (osteomyelitis). The bone infection may cause an epidural abscess to form. This abscess gets larger and presses on the spinal cord. The infection can spread to the cord itself.

The disorder is rare, but may be life threatening.

Symptoms

• Chills
• Fever
• Loss of bladder or bowel control
• Loss of movement of an area of the body below the abscess
• Loss of sensation of an area of the body below the abscess
• Low backache, often mild but slowly gets worse
  • Pain typically moves to the hip, leg, or feet
  • Pain may spread to the shoulder, arm, or hand
• Male impotence
• Severe back pain

Signs and tests

A physical exam often shows tenderness over the spine. An exam may show signs of:

• Spinal cord compression
• Paralysis of the lower body (paraplegia) or of the entire trunk, arms, and legs (quadriplegia)
• Changes in sensation below the area of involvement

The amount of nerve loss depends on where the lesion is located on the spine and how much it is compressing the spinal cord.

Tests that may be done:

• CT scan of the spine
• Draining of abscess
• Gram stain and culture of abscess material
• Examination of cerebrospinal fluid
• MRI of the spine

Treatment

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

• Urgent surgery to relieve the pressure is sometimes recommended. The surgery is called laminectomy. It involves removing part of the spine bone and draining the abscess. Sometimes it is not possible to completely drain the abscess.
• Medicines are prescribed to get rid of the infection. This may include a combination of antibiotics.
• Corticosteroids may occasionally be prescribed to reduce swelling and pressure on the spinal cord.

Support Groups

Expectations (prognosis)

How well a person does after treatment varies. Some people recover completely.

An untreated spinal cord abscess can lead to spinal cord compression. It can cause permanent, severe paralysis and nerve loss. It may be life-threatening.

If the abscess is not drained completely, it may return or cause scarring in the spinal cord.

Complications

The abscess can either injure the spinal cord from direct pressure, or it can cut off the blood supply to the spinal cord.

Complications may include:

• Long-term (chronic) back pain
• Loss of bladder/bowel control
• Loss of sensation
• Male impotence
• Weakness, paralysis

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of spinal cord abscess.

Prevention

Thorough treatment of boils, tuberculosis, and other infections decreases the risk.

People with endocarditis or congenital heart disorders may need to take preventive antibiotics before having dental or other mouth procedures.

References

Nath A. Brain abscess and parameningeal infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 438.