Spinal Cord Abscess Treatment & Management
- Author: Rod J Oskouian, Jr, MD; Chief Editor: Brian H Kopell, MD more...
Treatment involves a combination of 3 modalities: surgical drainage of the abscess cavity, identification of the infecting organism, and administration of appropriate antibiotics for a proper length of time.
During the entire course of treatment, steroids are used to reduce spinal cord swelling and edema associated with the abscess.
As mentioned in Lab Studies, cultures of the abscess cavity should include tests for aerobic and anaerobic bacteria, fungi, and tuberculosis. Slides looking for parasites are also recommended.
Prior to identifying the organism, administer a broad-spectrum antipenicillinase penicillin.
Once the organisms are identified and sensitivities established, the appropriate antibiotics can be administered.
Once MRI has localized the abscess, laminectomy is performed to expose the lesion and surrounding cord. Laminectomy is usually performed one level above and below the abscess edges for complete abscess visualization. The dura is opened and the area of spinal cord involvement, as indicated by swelling, hemorrhage, and distended veins, is identified.
At this point, aspiration of the lesion is performed for culture of both aerobic and anaerobic organisms, as well as for fungal infection and tuberculosis. Additionally, complete Gram stain and India ink preparation should be analyzed. A myelotomy over the length of the abscess is next performed, with complete drainage of the abscess cavity. Lastly, the wound and abscess cavity should be irrigated with an antibiotic solution, following by closure in anatomic layers. A drain is optional.
During the preoperative phases, dexamethasone is used to reduce cord swelling. The usual dosage is 4-10 mg every 6 hours.
Intravenous antibiotic therapy is continued for a minimum of 6 weeks following surgery. Similar to the preoperative period, dexamethasone can be used during the postoperative phase to reduce cord swelling. The usual dosage is 4-10 mg every 6 hours. Steroids are tapered on a delayed basis (eg, after 2 wk of treatment).
Obtain a follow-up MRI to detect recurrence of the abscess. However, enhancement of the cavity will likely continue for several weeks.
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