Spinal Cord Infections Workup

Updated: Sep 26, 2018
  • Author: Andrew K Chang, MD, MS; Chief Editor: Liudvikas Jagminas, MD, FACEP  more...
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Workup

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.

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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.

MRI

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.

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Procedures

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.

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