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


Spinal Cord Infections Workup

  • Author: Andrew K Chang, MD; Chief Editor: Robert E O'Connor, MD, MPH  more...
Updated: Dec 15, 2015

Laboratory Studies

A CBC count demonstrates leukocytosis only in the acute presentation (with or without neutrophilia).

Cerebrospinal fluid (CSF) analysis demonstrates the following:

  • Marked pleomorphic leukocytosis, increased protein level, and decreased glucose and chloride level may be noted in the rare patients in whom the abscess has ruptured into the subarachnoid space.
  • Often, mild leukocytosis (mostly polymorphonucleocytes) and protein level increase are observed.

Results from blood cultures occasionally are positive, showing the bacteriology of the underlying disease (eg, bacterial endocarditis, urosepsis).

CSF cultures usually are sterile.


Imaging Studies

Cervical, thoracic, or lumbar spine radiographs

Plain films are not helpful in diagnosing spinal cord abscesses and usually are normal.

If plain films show diskitis, osteomyelitis, or paraspinal infection, then one should suspect spread of contiguous infection into the spinal cord.

However, in patients in whom the abscess is associated with dysraphism, spina bifida can be demonstrated.

Myelography with contrast

A positive myelogram reveals an expanded spinal cord or a complete block.

Until recently, myelography was the most reliable diagnostic tool; MRI largely has replaced it.


To date, in the cases reported using MRI, the T1-weighted images exhibit decreased signal intensity. Peripheral enhancement, similar to that observed with abscesses of the brain, has been found with gadolinium.

MRI has become the preferred imaging technique, yielding not only the diagnosis but also the extent of the process.



Lumbar puncture

Do not attempt lumbar puncture if a dermal sinus is found in the lumbar area. Delay the procedure until a tethered cord syndrome has been excluded using computed tomography of the lumbar spinal canal.

Abdominal and jugular compression maneuvers with proper manometry may be indicated to establish the presence of a block to CSF flow. CSF manometer has been supplanted by neuroimaging, particularly MRI.

Jugular compression for manometric testing never should be performed if an intracranial mass is present.

Contributor Information and Disclosures

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, Society for Academic Emergency Medicine

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.

J Stephen Huff, MD, FACEP Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD, FACEP is a member of the following medical societies: American Academy of Neurology, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Heart Association, Medical Society of Delaware, Society for Academic Emergency Medicine, Wilderness Medical Society, American Medical Association, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Daniel J Dire, MD, FACEP, FAAP, FAAEM Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center San Antonio

Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, American Academy of Emergency Medicine, American College of Emergency Physicians, Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

  1. Kim MS, Ju CI, Kim SW, Lee HY. Recurrent bacterial meningitis accompanied by a spinal intramedullary abscess. J Korean Neurosurg Soc. 2012 Jun. 51(6):380-2. [Medline]. [Full Text].

  2. 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].

  3. Simon JK, Lazareff JA, Diament MJ, Kennedy WA. Intramedullary abscess of the spinal cord in children: a case report and review of the literature. Pediatr Infect Dis J. 2003 Feb. 22(2):186-92. [Medline].

  4. Rabadi MH, Mayanna SK, Vincent AS. Predictors of mortality in veterans with traumatic spinal cord injury. Spinal Cord. 2013 Jul 30. [Medline].

  5. Menezes AH, VanGilder JC. Spinal cord abscess. Wilkins RH, Rengachary SS. Neurosurgery. New York: McGraw-Hill; 1985. 1969.

  6. da Silva PS, de Souza Loduca RD. Intramedullary spinal cord abscess as complication of lumbar puncture: a case-based update. Childs Nerv Syst. 2013 Apr 5. [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 May. 18(5):710-7. [Medline].

  8. Bartels RH, Gonera EG, van der Spek JA, Thijssen HO, Mullaart RA, Gabreels FJ. Intramedullary spinal cord abscess. A case report. Spine. 1995 May 15. 20(10):1199-204. [Medline].

  9. 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].

  10. Byrne RW, von Roenn KA, Whisler WW. Intramedullary abscess: a report of two cases and a review of the literature. Neurosurgery. 1994 Aug. 35(2):321-6; discussion 326. [Medline].

  11. Cokca F, Meco O, Arasil E, Unlu A. An intramedullary dermoid cyst abscess due to Brucella abortus biotype 3 at T11-L2 spinal levels. Infection. 1994 Sep-Oct. 22(5):359-60. [Medline].

  12. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006 Nov 9. 355(19):2012-20. [Medline].

  13. David C, Brasme L, Peruzzi P, Bertault R, Vinsonneau M, Ingrand D. Intramedullary abscess of the spinal cord in a patient with a right-to-left shunt: case report. Clin Infect Dis. 1997 Jan. 24(1):89-90. [Medline].

  14. Desai KI, Muzumdar DP, Goel A. Holocord intramedullary abscess: an unusual case with review of literature. Spinal Cord. 1999 Dec. 37(12):866-70. [Medline].

  15. Dev R, Husain M, Gupta A, Gupta RK. MR of multiple intraspinal abscesses associated with congenital dermal sinus. AJNR Am J Neuroradiol. 1997 Apr. 18(4):742-3. [Medline].

  16. DiTullio MV Jr. Intramedullary spinal abscess: a case report with a review of 53 previously described cases. Surg Neurol. 1977 Jun. 7(6):351-4. [Medline].

  17. Hanci M, Sarioglu AC, Uzan M, Islak C, Kaynar MY, Oz B. Intramedullary tuberculous abscess: a case report. Spine. 1996 Mar 15. 21(6):766-9. [Medline].

  18. Hardwidge C, Palsingh J, Williams B. Pyomyelia: an intramedullary spinal abscess complicating lumbar lipoma with spina bifida. Br J Neurosurg. 1993. 7(4):419-22. [Medline].

  19. Hart J. Case of encysted abscess in the centre of the spinal cord. Dublin Hosp Rep. 1830. 5:522-524.

  20. Hoil-Parra JA, Lazareff JA. [Lumbar dermal sinus as a cause of intramedullary and subdural abscess. Report of 2 cases]. Bol Med Hosp Infant Mex. 1993 May. 50(5):341-6. [Medline].

  21. Hott JS, Horn E, Sonntag VK, Coons SW, Shetter A. Intramedullary histoplasmosis spinal cord abscess in a nonendemic region: case report and review of the literature. J Spinal Disord Tech. 2003 Apr. 16(2):212-5. [Medline].

  22. Lahdou JB, Gilliard C, de Coene BD, Vandercam B, Deltombe T, Hanson P. [Streptococcus milleri subacute spinal cord abscess. Apropos of a case]. Neurochirurgie. 1996. 42(2):100-4. [Medline].

  23. Lindner A, Becker G, Warmuth-Metz M, Schalke BC, Bogdahn U, Toyka KV. Magnetic resonance image findings of spinal intramedullary abscess caused by Candida albicans: case report. Neurosurgery. 1995 Feb. 36(2):411-2. [Medline].

  24. Manfredi M, Bozzao L, Frasconi F. Chronic intramedullary abscess of the spinal cord. Case report. J Neurosurg. 1970 Sep. 33(3):352-5. [Medline].

  25. Martin RJ, Yuan HA. Neurosurgical care of spinal epidural, subdural, and intramedullary abscesses and arachnoiditis. Orthop Clin North Am. 1996 Jan. 27(1):125-36. [Medline].

  26. Miranda Carus ME, Anciones B, Castro A, Lara M, Isla A. Intramedullary spinal cord abscess. J Neurol Neurosurg Psychiatry. 1992 Mar. 55(3):225-6. [Medline].

  27. Rogg JM, Benzil DL, Haas RL, Knuckey NW. Intramedullary abscess, an unusual manifestation of a dermal sinus. AJNR Am J Neuroradiol. 1993 Nov-Dec. 14(6):1393-5. [Medline].

  28. Tacconi L, Arulampalam T, Johnston FG, Thomas DG. Intramedullary spinal cord abscess: case report. Neurosurgery. 1995 Oct. 37(4):817-9. [Medline].

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

  30. Weng TI, Shih FY, Chen WJ, Lin FY. Intramedullary abscess of the spinal cord. Am J Emerg Med. 2001 Mar. 19(2):177-8. [Medline].

Graph showing age distribution of 91 patients with intramedullary spinal cord abscess. The age or gender of 14 patients is unknown.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.