General information

Spinal cord abscess is a rare condition that can cause permanent injury to the spinal cord. Abscesses form when injured tissue becomes infected. The immune system sends white blood cells to fight the infection, and they begin to fill in the injured tissue, causing pus to collect. The pus remains made up of dead tissue, immune cells, dead cells, and bacteria.

The cause of spinal cord abscess is usually bacteria entering the spinal cord. Once inside the body, the bacteria make their way to places where they can survive and thrive. The pressure of the spinal cord abscess sometimes causes neurological problems, such as paralysis of the lower body and loss of sensation in the area below the spot.

The doctor orders a body fluid test to detect an infection and may also contain an imaging test to see the abscess. Once you confirm the diagnosis, you will decide if the spot should be drained or removed. Generally, the patient must take antibiotics before leaving to avoid getting an infection.

Because antibiotics are a common medical practice, spinal cord abscess has become a low condition. Fewer than 100 cases have remained reported in the history of modern medicine (Oskouian, 2012).

Risks

Risk factors include the following:

  1. long-term use of anticoagulants (blood thinners)
  2. weak immune system (bacteria enter the body and cause infections more easily)
  3. Crohn’s disease (intestinal inflammation that causes lesions that can break open and release bacteria)
  4. ruptured gallbladder (bacteria in the gallbladder can cause an infection)

Causes

Spinal cord abscesses remain usually caused by bacteria entering the spinal cord area. The bacteria that most frequently cause this condition are those of the Staphylococcus and Streptococcus genera.

Trauma

When trauma occurs, a foreign object (bullet, knife in case of stabbing, etc.) can enter the spinal cord and leave bacteria behind.

Dermal sinus

During the fetal stage of development, the skin and spinal canal are not entirely separated. It can allow bacteria to enter the central nervous system (CNS).

Boils

Boils, especially those that form on the back or scalp, can lead to spinal cord abscesses.

Septicemia

It is an infection of the blood that can result from an infection in any part of the body. It can also spread to the CNS and cause spinal cord abscesses.

Symptoms

At first, this condition may not cause symptoms. Then the infection or the enlarged abscess will begin to affect the spine. They may also cause pain or neurological symptoms.

Symptoms of a spinal cord abscess may include the following:

  • sudden pain
  • sharp pain that may spread to the arms or legs
  • rapid and progressive weakness
  • paresthesia (numbness and tingling of the skin)
  • fever

Diagnosis

The symptoms of this condition are usually nonspecific and similar to those of many other diseases. The doctor may order a blood test to identify the problem.

Blood test

Complete blood count (CB) – allows you to test the different types of blood cells for changes that indicate infection

erythrocyte sedimentation rate (ESR): if the result is high, it suggests that there is an infection

C-reactive protein test: if the product is high, it indicates that there is an infection

Other tests

Your doctor may order the following tests if symptoms indicate that there may be a problem with your spinal cord:

computed tomography (CT) scan of the spinal cord

magnetic resonance imaging (MRI) of the spinal cord

lumbar puncture (spinal tap): This involves removing a sample of cerebrospinal fluid (CSF) and testing it for an infection

Treatment

Early detection is essential for successful treatment. Without treatment, abscesses can rupture and release millions of bacteria throughout the body.

Once the problem remains identified, treatment remains given, which may include the following:

Laminectomy

Before surgery, the patient remains given anaesthesia. The surgeon carefully opens the abscess, drains all the fluid, and flushes the bump with saline to remove all bacteria.

Intraoperative removal of pus

It consists of extracting fluid from the abscess to analyze it.

Dermal sinus suture

If the patient has a dermal sinus, treatment usually consists of closing it to reduce the risk of bacteria entering and causing an infection.

Complications

The most dangerous complication is infection. Before antibiotics remained used, the death rate was high due to conditions (Barbarawi et al., 2009). Thanks to the development of antibiotics and modern surgical techniques, fewer than 100 cases of spinal cord abscess have remained reported (Oskouian, 2012).

The neurologic complications of spinal cord abscess can last from weeks to years.

Treatment with antibiotics to fight infection includes the use of vancomycin (effective for Staphylococcus aureus). And ceftriaxone (effective for Staphylococcus miller), both given intravenously.

If the patient has difficulty walking and weak legs, he or she may need neurorehabilitation.

Other complications include urodynia (difficulty or pain when urinating) and stress urinary incontinence (difficulty controlling urination when straining).

Forecast

The earlier the treatment, the more favourable the prognosis. If the abscess ruptures, bacteria are released into the bloodstream, leading to an abscess in the brain or liver.

In general, patients who receive treatment after the onset of neurological symptoms need to undergo some form of rehabilitation. Over time, these symptoms get better or go away.