A spinal cord abscess is a serious medical condition characterized by a collection of pus and infected material forming in or around the spinal cord. This accumulation leads to swelling and irritation, which can exert pressure on the delicate spinal cord. It indicates an active infection within the spinal column and necessitates immediate medical intervention to prevent severe and potentially lasting damage.
How They Develop
A spinal cord abscess typically originates from a bacterial infection within the spine. While an abscess directly within the spinal cord tissue is uncommon, it frequently arises as a complication of a spinal epidural abscess, which forms in the space surrounding the spinal cord’s protective membrane. The most frequent bacterial culprits are Staphylococcus aureus and various gram-negative bacilli.
Bacteria can reach the spine through several pathways. Infections elsewhere in the body, such as skin boils, urinary tract infections, or dental abscesses, can spread through the bloodstream to the spine, a process known as hematogenous spread. Direct introduction of bacteria can also occur due to trauma, spinal surgery, or procedures like epidural injections. Additionally, vertebral osteomyelitis, an infection of the spinal bones, can lead to an epidural abscess that expands and presses on the spinal cord.
Recognizing the Signs
Symptoms often begin with localized or radiating back pain, which can be severe and worsen when lying down. This pain is frequently accompanied by fever and chills, indicating an active infection. Early in the progression of the abscess, these might be the only noticeable signs.
As the abscess grows and puts increasing pressure on the spinal cord, neurological symptoms begin to emerge and typically progress over hours to days. These can include weakness, numbness, or tingling sensations in the arms or legs. Individuals may experience difficulty walking or partial paralysis in affected limbs. Changes in bowel or bladder control, such as an inability to fully empty the bladder or difficulty controlling bowel movements, can occur.
Medical Identification and Management
Diagnosing a spinal cord abscess begins with a thorough physical and neurological examination, where a healthcare provider may detect tenderness over the spine, signs of spinal cord compression, or changes in sensation and movement. Imaging studies are performed to confirm the diagnosis and pinpoint the abscess’s exact location and size. Magnetic Resonance Imaging (MRI) of the spine is the most definitive diagnostic method, providing detailed images of the spinal cord and surrounding tissues. If an MRI is not immediately available, myelography followed by computed tomography (CT) can be used.
Blood tests assess for signs of infection, such as an elevated white blood cell count and increased inflammatory markers. In some cases, a lumbar puncture may be performed, though precautions are taken due to the risk of complications. Once diagnosed, management typically involves a dual approach: antibiotic therapy and surgical drainage.
Antibiotics are administered intravenously, often starting with broad-spectrum agents to cover common bacteria. Once culture results identify the specific bacteria, the antibiotic regimen can be tailored for more targeted treatment, typically lasting four to six weeks. Surgical drainage, often involving a laminectomy to remove part of the spinal bone, is performed immediately if the abscess is causing neurological deficits like weakness, paralysis, or loss of bladder or bowel control. The goal of surgery is to relieve pressure on the spinal cord and remove the infected material, though complete drainage is not always possible.
Potential Outcomes
The outcome for individuals with a spinal cord abscess varies depending on factors such as the abscess’s size, location, and the severity of neurological symptoms at the time of diagnosis and treatment. Prompt diagnosis and aggressive treatment significantly improve the prognosis. If left untreated, a spinal cord abscess can lead to severe and permanent neurological deficits.
Lasting complications can include permanent weakness or paralysis in the limbs, persistent sensory loss, and irreversible bladder or bowel dysfunction. The abscess can cause direct injury to the spinal cord through compression or by disrupting its blood supply. Recovery may involve neuro-rehabilitation to address any remaining neurological impairments and to help patients regain function.