A spinal cord abscess is a serious and uncommon infection involving a collection of pus near the spinal cord. This condition can develop when bacteria from other parts of the body spread to the spinal area. If not addressed promptly, it can lead to severe complications. The connection between a skin manifestation, such as a cyst, and a spinal cord abscess often involves a specific type of birth defect.
The Skin-Spinal Cord Connection
A spinal cord abscess is a localized collection of pus, typically from a bacterial infection, forming within or around the spinal cord. This infected material can put pressure on the spinal cord and surrounding nerve structures. The primary way a skin issue can lead to a spinal cord abscess is through congenital dermal sinus tracts or dermal cysts.
Congenital dermal sinus tracts are rare birth defects. These are small channels lined with skin tissue that extend inward from the skin surface, often along the midline of the back, towards the spinal canal. This direct communication allows bacteria from the skin to reach deeper neural structures, potentially leading to infections like meningitis or abscesses.
Dermal cysts, such as epidermoid or dermoid cysts, can also be associated with these tracts. These sacs of tissue can form along the path of the dermal sinus. If infected, they can contribute to a spinal abscess. While less common, severe skin infections like boils can also spread to the spinal area through the bloodstream, but dermal sinus tracts offer a more direct route for infection.
Identifying the Symptoms
Symptoms of a spinal cord abscess vary depending on its location and severity. One of the earliest and most common signs is localized back pain, which can become severe and may worsen when lying down. This pain can sometimes radiate to the arms or legs, depending on the affected spinal region.
As the abscess expands and presses on the spinal cord, neurological symptoms may develop. These include weakness or numbness in the legs or arms, difficulty walking, and changes in reflexes. Bowel or bladder dysfunction, such as difficulty controlling urination or defecation, can also occur.
Infection symptoms, such as fever and chills, are frequently present. When a dermal sinus tract is involved, there may be visible skin manifestations. These can appear as a small dimple, a patch of abnormal hair growth, skin discoloration, or a tiny opening on the skin, most commonly found along the midline of the lower back. These skin signs might also show local infection, such as redness, swelling, or drainage, which can precede or accompany the spinal abscess.
How It Is Diagnosed
Diagnosing a spinal cord abscess involves clinical assessment and specialized tests. A doctor will begin with a thorough clinical examination, evaluating the patient’s symptoms and looking for physical signs, including any visible skin anomalies.
Imaging tests confirm the diagnosis and determine the abscess’s location and extent. Magnetic Resonance Imaging (MRI) of the spine is the primary diagnostic tool for visualizing spinal infections. An MRI can show the abscess, surrounding inflammation, and any associated congenital anomalies like dermal sinus tracts. If an MRI is not feasible, a Computed Tomography (CT) scan with intravenous contrast or a CT myelogram may be used to provide detailed images of the spinal cord and bony structures.
Laboratory tests are also used for diagnosis. Blood tests, such as a complete blood count (CBC), can reveal an elevated white blood cell count, indicating an infection. Inflammatory markers like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are typically elevated in cases of spinal epidural abscess. Blood cultures are often obtained before starting antibiotics, as they can identify the specific bacteria causing the infection. In some instances, a lumbar puncture may be performed to analyze cerebrospinal fluid.
Treatment Options
Treatment for a spinal cord abscess typically involves medical and surgical interventions. Intravenous antibiotics are a primary treatment, often administered for an extended period. The specific antibiotics chosen are tailored to the type of bacteria identified through cultures.
Surgical drainage is frequently necessary, particularly for large abscesses, those causing neurological deficits, or those not responding adequately to antibiotics. The surgical procedure involves removing a portion of the spinal bone to access and drain the abscess, relieving pressure on the spinal cord. This helps to preserve neurological function and remove infected material.
If a congenital dermal sinus tract or cyst is the source of the infection, surgical excision of this tract is often required after the acute abscess is treated. This helps minimize the risk of recurrence by eliminating the pathway for future infections. Supportive care, including pain management and monitoring for neurological changes, is also provided.
Recovery and Prognosis
The outcome for individuals with a spinal cord abscess varies, with early diagnosis and prompt treatment leading to a more favorable prognosis. Delay in diagnosis and treatment can lead to more widespread infections and permanent damage to the spinal cord. Factors influencing recovery include the extent of neurological deficit present before treatment, the size and location of the abscess, and the patient’s overall health.
Potential long-term complications include persistent neurological deficits, such as ongoing weakness, numbness, or issues with bladder and bowel control. In some cases, chronic back pain may also persist. For patients who experience neurological symptoms after initial treatment, rehabilitative therapy, including physical and occupational therapy, can be beneficial in regaining movement and function.
Long-term medical follow-up is important to monitor for any recurrence of the infection or ongoing neurological issues. While some individuals may achieve complete recovery, others may be left with varying degrees of neurological impairment.