Spinal Cord Abscess Treatment & Management

Updated: Mar 11, 2022
  • Author: Rod J Oskouian, Jr, MD; Chief Editor: Brian H Kopell, MD  more...
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Treatment

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 an appropriate 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.

Before the organism is identified, a broad-spectrum antipenicillinase penicillin should be administered.

Once organisms are identified and sensitivities established, appropriate antibiotics can be administered.

Complications associated with ISCA consist of bowel and bladder incontinence, paraplegia, dysesthesia, and weakness. [3]

Potential consultations may involve neurologists, neurosurgeons, infectious disease specialists, and physical medicine and rehabilitation doctors. [3]   [3]

Next:

Surgical Therapy

Once MRI has localized the abscess, laminectomy is performed to expose the lesion and the surrounding cord. [18] Laminectomy is usually performed 1 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, the lesion is aspirated for culture of both aerobic and anaerobic organisms, as well as for fungal infection and tuberculosis. Additionally, a complete Gram stain and India ink preparation should be analyzed. A myelotomy over the length of the abscess is performed next, with complete drainage of the abscess cavity. Finally, the wound and the abscess cavity are irrigated with an antibiotic solution, and closure is performed in anatomic layers. A drain is optional. [13]

During 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 weeks of treatment).

Follow-up MRI will detect recurrence of the abscess. However, enhancement of the cavity will likely continue for several weeks.

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