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Spinal Cord Abscess Workup

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

Laboratory Studies

Cerebrospinal fluid (CSF) examination may show elevated protein and leukocyte levels but can be within reference ranges.

Cultures with sensitivities from abscess aspirate are needed to identify infective organisms. Cultures should include tests for aerobic and anaerobic bacteria, fungi, and tuberculosis. Slides should also be taken to look for parasites. Even with appropriate culture techniques, 25-40% of abscesses are microbiologically sterile.


Imaging Studies

The procedure of choice for diagnosing a possible intramedullary spinal cord abscess is gadolinium-enhanced MRI.[9, 10, 11, 12, 13]  If a high probability of spinal abnormality is present, an MRI of the area will demonstrate the mass. MRI is also valuable in demonstrating any associated disease process (eg, epidural or subdural infection, bone involvement, dermal sinus).[14]

MRI does not differentiate among the types of masses (ie, between tumor and abscess), although an abscess generally demonstrates ring-enhancement, while a metastatic lesion generally demonstrates a nodular pattern of enhancement.

Spinal cord abscesses produce homogeneous spinal cord enlargement on T1-weighted images but produce high signal intensity on T2-weighted images. The abscess margin enhances brightly with gadolinium.

Diffusion-weighted imaging (DWI) with a b-value of 1000 and apparent diffusion coefficient (ADC) maps provide early and accurate detection of abscess and pus collection. DWI is useful not only for the diagnosis but also for the treatment planning of pyogenic and non-pyogenic spinal infections[13]

Most other diagnostic modalities are ineffectual in showing an abscess. Plain radiographs show only bony changes (if present). Myelography usually shows only widening of the spinal cord.

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.

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Abscess that compresses the spinal cord and its vasculature.
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