Spinal Cord Abscess Workup

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

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.