Spinal Cord Infections Treatment & Management
- Author: Andrew K Chang, MD; Chief Editor: Robert E O'Connor, MD, MPH more...
Because the course of this condition is measured in days and not in hours (some patients take several months to present to medical care), patients' arrival by Emergency Medical Services (EMS) transport is unlikely.
If presented with a patient who requires EMS transport, oxygen, analgesia, and a position of comfort are the only treatments needed in the prehospital arena.
In patients in whom meningismus is involved, antiemetics and gentle handling are indicated.
Emergency Department Care
Because this is such a rare entity, making the diagnosis in the ED is likely difficult. The emergency physician should consider the diagnosis when an infectious picture is present along with neurologic deficits originating at the spinal cord level.
Treatment goals include making an accurate diagnosis and starting antibiotics as early as possible.
Determining the extent of the motor and sensory deficit and its levels is important to guide diagnostic modalities later. Examine the cervical, dorsal, and lumbar regions carefully looking for dermal sinuses, suggestive lesions, and signs of local infection.
Plain radiography of the involved spinal levels occasionally can offer a clue when abnormal.
A lumbar puncture always is considered in a patient with a septic picture with neurologic involvement; however, remember that besides cell count, protein, glucose, and bacteriologic studies, manometric maneuvers can establish the diagnosis of CSF block. Again, neuroimaging (especially MRI) of the spine has made CSF manometry largely obsolete for detecting spinal canal block. If a dermal sinus is found in the lumbar region, deferring the lumbar puncture until the absence of a tethered cord syndrome can be ascertained is prudent.
Start antibiotics as soon as the bacteriologic workup samples have been obtained. Concomitant risk factors determine the most optimal antibiotic coverage for each individual patient.
The use of steroids to treat spinal cord swelling should be made in consultation with neurosurgery.
For additional information, see Spinal Cord Abscess and Spinal Cord Tumors - Management of Intradural Intramedullary Neoplasms.
The neurosurgeon should be involved early to guide the diagnostic flow toward surgery.
An infectious disease consultant can offer invaluable help regarding the best antimicrobial combination.
Consult a neuroradiologist to read the MRI with gadolinium study.
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