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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.

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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.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

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Abscess that compresses the spinal cord and its vasculature.
 
 
 
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