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Spinal cord abscess
Definition Spinal cord abscess is 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 that occurs inside 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 is commonly enclosed by a lining or membrane that forms around the edges. The pus collection 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 due to a fungus or virus. 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 following increase your risk of a spinal cord abscess: - Boils on the skin, particularly on the back or scalp
- Spread of any infection through the bloodstream from another body location (bacteremia)
- Back injuries or trauma, including minor ones
- Complication of lumbar puncture or back surgery
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 - Chills
- Fever
- Loss of bladder or bowel control
- Loss of movement of an area of the body
- Loss of sensation of an area of the body
- Low back ache, 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
- Numbness in a specific, limited area (localized)
- Sudden or rapid worsening of neurologic symptoms
- Weakness or paralysis
Signs and tests A physical exam often shows localized tenderness over the spine. A neurological examination may show signs of spinal cord compression, with involvement of the lower body (paraplegia) or the entire trunk, arms, and legs (quadriplegia). The extent of nerve loss corresponds with the location of the lesion on the spine and the amount of spinal cord compression. Tests that may be done: - Examination of cerebrospinal fluid
- CT scan
- MRI
- Draining of abscess and culture of abscessed material
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. Sometimes it is not possible to completely drain the abscess. Medicines are prescribed to kill the organism responsible for the infection. This may include antimicrobials or a combination of antibiotics. Corticosteroids may occasionally be prescribed to reduce swelling and compression of the spinal cord. Expectations (prognosis) An untreated spinal cord abscess leads to spinal cord compression that causes permanent, severe paralysis and other nerve losses. It may be life threatening. How well a person does after treatment may vary. Some have a complete recovery. Incomplete drainage may result in a return of the abscess or scarring in the spinal cord. Complications The abscess can either injure the spinal cord from direct pressure, or can cut off the blood supply to the spinal cord, leading to a stroke of the cord. In either case, neurological function below the abscess area is greatly impaired. Permanent neurologic losses vary but may include: - Loss of sensation
- Loss of bladder/bowel control
- 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 be advised to take preventive antibiotics prior to dental or other mouth procedures. Review date: 8/14/2007 Reviewed By: Arnold L. Lentnek, MD, Division of Infectious Disease, Kennestone Hospital, Marietta, GA. Review provided by VeriMed Healthcare Network.
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