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Spinal cord abscess

Spinal cord abscess is swelling and irritation (inflammation) and the collection of infected material (pus) in or 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

Signs and tests

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

  • 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 materia
  • 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. It involves removing part of the spine bone and draining the abscess. Sometimes it is not possible to completely drain the abscess.

Antibiotics are used to treat the infection. They are usually given through a vein (IV).   

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:

  • Infection returns
  • 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. Early diagnosis and treatment are essential to prevent complications. 

References

Nath A, Berger J. Brain abscess and parameningeal infections. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 421.

Tunkel AR. Subdural empyema, epidural abscess, and suppurative intracranial thrombophlebitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 89.

Updated: 10/6/2012

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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