Spinal Cord Abscesses

Abstract

Spinal cord abscess is a focal suppurative collection within the spinal cord parenchyma. It is a rare infection of the central nervous system with potential permanent neurologic damage. Spinal cord abscesses are more common in children, particularly those with congenital midline defects. Clinically, acute forms present as acute transverse myelitis, but chronic abscesses tend to have less-specific symptoms that mimic spinal cord tumors. MRI with gadolinium injection is the imaging technique of choice. The microorganisms most often responsible for spinal cord abscess are Staphylococcus aureus and Streptococcus species. Anaerobic and fungal infections are rare. Classically, treatment of intramedullary abscesses involves laminectomy, myelotomy, and surgical drainage of the abscess cavity, followed by the administration of appropriate antibiotics, although medical therapy alone may be appropriate in some cases. Good clinical recovery is predictable for many patients and the mortality rate is low, but the prognosis of spinal cord abscess depends on the patient’s general health, the delay in diagnosis and treatment, and the response to therapy. Common complications include paraplegia, sphincter dysfunctions, recurrence, meningitis, spinal cord infarction, sepsis, and even death.