Spinal cord abscess (SCA) is a rare condition capable of causing permanent damage to the spinal cord. Abscesses are caused when injured tissue becomes infected. The body’s immune system sends white blood cells to help fight off the infection. They begin to fill the damaged tissue, causing pus to build up. Pus is made up of the dying tissue, immune cells, dead cells, and bacteria.
The cause of SCA is generally due to the introduction of bacteria into the spinal cord. Once inside the body, it is able to find a place to live and grow. The pressure of the abscess on the spinal cord will sometimes cause neurological problems, such as lower-body paralysis and loss of sensation below the area of the abscess.
Doctors will try to find the presence of an infection by testing body fluids. They may also look at an image of the abscess. Once the diagnosis is confirmed, they will have to either drain or remove the abscess. Patients will generally receive antibiotics to take after they leave to avoid getting an infection.
Since antibiotics have come into common medical use, SCA has become extremely rare. In fact, fewer than 100 cases have been reported in modern medical history (Oskouian, 2012).
Risk factors include:
- long-term use of anticoagulant agents (blood thinners)
- a weakened immune system (easier for bacteria to enter and infect the body)
- Crohn’s disease (an inflammation of the bowel, lesions from the disease may burst, releasing bacteria)
- ruptured gallbladder (bacteria from gallbladder may start an infection)
Spinal cord abscesses are generally caused by the introduction of bacteria into the spinal cord area. The most common bacteria to cause abscesses to develop in the spinal cord are from the Staphylococcus and Streptococcus species.
In the case of trauma, a foreign object (bullet, knife in a stabbing, etc.) enters the spinal area and leaves bacteria behind.
During development in the womb, there isn’t a complete separation between skin and the spinal canal. This could be a potential entrance for bacteria to the central nervous system (CNS).
Boils on the skin, especially on the back or scalp, can lead to spinal cord abscesses.
This is an infection of the blood that can be caused by infection anywhere in the body. It can also spread to the CNS, leading to the development of spinal cord abscess.
At first, SCA may have no symptoms. Infection or enlargement of the abscess will begin to affect the spine’s abilities. Pain or neurological symptoms may also develop.
Symptoms of SCA may include:
- sudden onset of pain
- sharp pain that can radiate to arms or legs
- rapid progressive weakness
- parasthesia (numbness, tingling of the skin)
The symptoms of SCA are often vague and can indicate many diseases. Doctors may start with a blood test to get an idea of the problem.
- complete blood count (CBC): looks at different blood cell types to see changes indicating presence of infection
- erythrocyte sedimentation rate (ESR): elevated rates point to infection
- C-reactive protein: elevated levels point to infection
Doctors may use these tests if the symptoms indicate a possible issue with the spinal cord:
- computed tomography (CT) scan of the spinal cord
- magnetic resonance imaging (MRI) of the spine cord
- lumbar puncture (spinal tap): removes a sample of cerebrospinal fluid (CSF) and tests for infection
Quick recognition of SCA is important in effectively treatment. Left alone, the abscess could burst, letting millions of bacteria spread throughout the body.
Once the problem is identified, treatment for SCA can include:
The patient is put under anesthesia before the surgery. Surgeons open the abscess carefully and drain all the fluid. They then rinse sanitary saline fluid through the abscess to assure all bacteria are gone.
Intraoperative Pus Collection
During this procedure, fluid is collected from the abscess for testing.
Closure of Dermal Sinus
Doctors who find a dermal sinus will typically close the gap. The hope is there will be one less place for bacteria to gather and form an infection.
The most dangerous complication of a SCA is infection. Before the use of antibiotics, the rate of mortality was high from the development of infections (Barbarawi et al., 2009). Since the advent of antibiotics and modern surgical techniques, there have been fewer than 100 reported cases of spinal cord abscesses(Oskouian, 2012).
Neurological complications caused by the presence of SCA may remain for weeks to years.
Antibiotic treatment for infection includes intravenous vancomycin (effective for cases of Staphylococcus aureus) and intravenous ceftriaxone (effective for cases of Staphylococcus milleri).
Neurorehabilitation may be needed for those experiencing difficulty walking and leg weakness.
Other complications present may include dysuria (difficult or painful urination) and stress incontinence (difficulties controlling urination under stress).
The earlier a spinal cord abscess is treated, the more positive the outlook. Patients who have a leaking abscess are unleashing bacteria into the bloodstream. They could end up with abscesses on the brain or liver.
Patients who get treatment after the start of neurological symptoms generally will need a form of rehabilitation. The hope is that over time the neurological symptoms will get better or disappear.