Medscape is available in 5 Language Editions – Choose your Edition here.


Spinal Cord Abscess Treatment & Management

  • Author: Rod J Oskouian, Jr, MD; Chief Editor: Brian H Kopell, MD  more...
Updated: May 04, 2016

Medical Therapy

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.


Surgical Therapy

Once MRI has localized the abscess, laminectomy is performed to expose the lesion and surrounding cord.[10] 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.[5]

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.

Contributor Information and Disclosures

Rod J Oskouian, Jr, MD Consulting Physician, Swedish Neuroscience Specialists, Swedish Neuroscience Institute, Seattle

Rod J Oskouian, Jr, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, North American Spine Society, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.


Charles E Rawlings III, MD Consulting Surgeon, Department of Neurosurgery, Rawlings Neurosurgical Consulting

Charles E Rawlings III, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, International Parkinson and Movement Disorder Society, Congress of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from St Jude Neuromodulation for consulting; Received consulting fee from MRI Interventions for consulting.

Additional Contributors

Paul L Penar, MD, FACS Professor, Department of Surgery, Division of Neurosurgery, Director, Functional Neurosurgery and Radiosurgery Programs, University of Vermont College of Medicine

Paul L Penar, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, World Society for Stereotactic and Functional Neurosurgery, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

  1. Yuceer N, Senoglu M, Arda MN. Intramedullary spinal cord abscess in a 4-year old child. Acta Neurochir (Wien). 2004 Nov. 146(11):1273-4. [Medline].

  2. Takebe N, Iwasaki K, Hashikata H, Toda H. Intramedullary spinal cord abscess and subsequent granuloma formation: a rare complication of vertebral osteomyelitis detected by diffusion-weighted magnetic resonance imaging. Neurosurg Focus. 2014 Aug. 37 (2):E12. [Medline].

  3. Kamat AS, Thango NS, Husein MB. Proteus mirabilis abscess involving the entire neural axis. J Clin Neurosci. 2016 Mar 5. [Medline].

  4. Arnáiz-García ME, González-Santos JM, López-Rodriguez J, Dalmau-Sorli MJ, Bueno-Codoñer M, Arévalo-Abascal A. Intramedullary cervical abscess in the setting of aortic valve endocarditis. Asian Cardiovasc Thorac Ann. 2015 Jan. 23 (1):64-6. [Medline].

  5. Whitson WJ, Ball PA, Lollis SS, Balkman JD, Bauer DF. Postoperative Mycoplasma hominis infections after neurosurgical intervention. J Neurosurg Pediatr. 2014 Aug. 14 (2):212-8. [Medline].

  6. McCaslin AF, Lall RR, Wong AP, Lall RR, Sugrue PA, Koski TR. Thoracic spinal cord intramedullary aspergillus invasion and abscess. J Clin Neurosci. 2015 Feb. 22 (2):404-6. [Medline].

  7. Al Barbarawi M, Khriesat W, Qudsieh S, Qudsieh H, Loai AA. Management of intramedullary spinal cord abscess: experience with four cases, pathophysiology and outcomes. Eur Spine J. 2009 Jan 27. [Medline].

  8. Akhaddar A, Boulahroud O, Boucetta M. Chronic spinal cord abscess in an elderly patient. Surg Infect (Larchmt). 2011 Aug. 12(4):333-4. [Medline].

  9. Samkoff LM, Monajati A, Shapiro JL. Teaching NeuroImage: nocardial intramedullary spinal cord abscess. Neurology. 2008 Jul 15. 71(3):e5. [Medline].

  10. Ebner FH, Roser F, Acioly MA, Schoeber W, Tatagiba M. Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management. Neurosurg Rev. 2008 Sep 27. [Medline].

  11. Hood B, Wolfe SQ, Trivedi RA, Rajadhyaksha C, Green B. Intramedullary abscess of the cervical spinal cord in an otherwise healthy man. World Neurosurg. 2011 Sep-Oct. 76(3-4):361.e15-9. [Medline].

  12. Roh JE, Lee SY, Cha SH, Cho BS, Jeon MH, Kang MH. Sequential magnetic resonance imaging finding of intramedullary spinal cord abscess including diffusion weighted image: a case report. Korean J Radiol. 2011 Mar-Apr. 12(2):241-6. [Medline]. [Full Text].

  13. Moritani T, Kim J, Capizzano AA, Kirby P, Kademian J, Sato Y. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol. 2014 Sep. 87 (1041):20140011. [Medline].

  14. Kurisu K, Hida K, Yano S, Yamaguchi S, Motegi H, Kubota K, et al. [Case of a large intra and extra medullary abscess of the spinal cord due to dermal sinus]. No Shinkei Geka. 2008 Dec. 36(12):1127-32. [Medline].

  15. Arzt PK. Abscess within the spinal cord: review of the literature and report of three cases. Arch Neurol Psychiatry. 1944. 51:533-543.

  16. Benzil DL, Epstein MH, Knuckey NW. Intramedullary epidermoid associated with an intramedullary spinal abscess secondary to a dermal sinus. Neurosurgery. 1992 Jan. 30(1):118-21. [Medline].

  17. Blacklock JB, Hood TW, Maxwell RE. Intramedullary cervical spinal cord abscess. Case report. J Neurosurg. 1982 Aug. 57(2):270-3. [Medline].

  18. Chan CT, Gold WL. Intramedullary abscess of the spinal cord in the antibiotic era: clinical features, microbial etiologies, trends in pathogenesis, and outcomes. Clin Infect Dis. 1998 Sep. 27(3):619-26. [Medline].

  19. Ginsburg S, Gross E, Feiring EH. The neurological complications of tuberculous spondylitis. Pott's paraplegia. Arch Neurol. 1967 Mar. 16(3):265-76. [Medline].

  20. Guzel N, Eras M, Guzel DK. A child with spinal intramedullary abscess. Childs Nerv Syst. 2003 Nov. 19(10-11):773-6.

  21. Kumar S, Gulati DR. Spinal abscesses. A report on 22 cases. Neurol India. 1978 Dec. 26(4):193-5. [Medline].

  22. Marwah RK, Khosla VK, Agarwal KC. Intramedullary spinal cord abscess. Indian Pediatr. 1985 Jan. 22(1):71-4. [Medline].

  23. Menezes AH, Graf CJ, Perret GE. Spinal cord abscess: a review. Surg Neurol. 1977 Dec. 8(6):461-7. [Medline].

  24. Menezes AH, Van Gilder JC. Spinal cord abscess. Neurosurgery. 1966. 3323-3326.

  25. Schroeder KA, McKeever PE, Schaberg DR. Effect of dexamethasone on experimental brain abscess. J Neurosurg. 1987 Feb. 66(2):264-9. [Medline].

  26. Tewari MK, Devi BI, Thakur RC. Intramedullary spinal cord abscess: a case report. Childs Nerv Syst. 1992 Aug. 8(5):290-1. [Medline].

  27. Vajramani GV, Nagmoti MB, Patil CS. Neurobrucellosis presenting as an intra-medullary spinal cord abscess. Ann Clin Microbiol Antimicrob. 2005. 4:14. [Medline].

  28. Vora YA, Raad II, McCutcheon IE. Intramedullary abscess from group F Streptococcus. Surg Infect (Larchmt). 2004. 5(2):200-4.

  29. Wright RL. Intramedullary spinal cord abscess. Report of a case secondary to stab wound with good recovery following operation. J Neurosurg. 1965 Aug. 23(2):208-10. [Medline].

Abscess that compresses the spinal cord and its vasculature.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.