Further Inpatient Care

Laminectomy is the treatment of choice once the provisional diagnosis is made. Then, opening of the dura, needle aspiration of the abscess (with pus bacteriology), midline myelotomy with drainage of the cavity, abundant irrigation, and closure by layers are performed.

The dura mater preferably is closed with a graft, if needed, once decompression has been accomplished. Although marsupialization has been tried occasionally, it generally is not recommended.

In children, all cases of abscesses with concomitant isolated dermal sinus presented when the child was older than 6 months of age, which suggests that complete resection of the dermal sinus before 6 months of age may prevent the formation of intramedullary spinal cord abscess and its significant morbidity and mortality.

Complications

Complications include the following:

Sepsis
Neurologic sequelae (70%)
Death

Prognosis

Prognosis of spinal cord infection was grim in the preantibiotic era. Currently, with prompt diagnosis, early surgery, and correct antibiotic therapy, the chances for full or almost full recovery often are very good.

Early surgery is the key to recovery for patients in the acute category.

Prognosis generally is better for patients in the chronic and subacute categories.

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Media Gallery

Graph showing age distribution of 91 patients with intramedullary spinal cord abscess. The age or gender of 14 patients is unknown.

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Author

Andrew K Chang, MD, MS Vincent P Verdile, MD, Endowed Chair in Emergency Medicine, Professor of Emergency Medicine, Vice Chair of Research and Academic Affairs, Albany Medical College; Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Emergency Medicine, Montefiore Medical Center

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

Liudvikas Jagminas, MD, FACEP Chief of Service, Attending Physician, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Vice-Chair for Network Development, Department of Emergency Medicine, Beth Israel Deaconess and Harvard Medical Faculty Physicians; Adjunct Associate Professor of Emergency Medicine, The Warren Alpert Medical School of Brown University

Liudvikas Jagminas, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, International Trauma Anesthesia and Critical Care Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Daniel J Dire, MD, FACEP, FAAP, FAAEM Professor of Pediatrics and Emergency Medicine, University of Texas Health Science Center at San Antonio, Joe R and Teresa Lozano Long School of Medicine

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

Disclosure: Nothing to disclose.

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 Heart Association, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.