What is a spinal cord abscess?

A spinal cord abscess (SCA) is a rare condition than can cause permanent damage to your spinal cord. An abscess is a swollen area in your tissues that contains a buildup of pus. It happens when injured tissues becomes infected. Your body’s immune system sends white blood cells to help fight off infection. The white blood cells begin to fill the damaged tissue, causing pus to build up. Pus is made up of dead cells, immune cells, and bacteria.

Since antibiotics have become widespread, SCAs have become extremely rare. If you develop one, your doctor will likely use surgery and antibiotics to treat it. They may also recommend rehabilitative therapy to help you recover from neurological symptoms.

At first, an SCA may produce no symptoms. But as the infection or abscess grows, it can put pressure on your spinal cord. The infection and pressure can cause potentially serious symptoms, such as:

  • sudden onset of pain
  • sharp pain that can radiate to your arms or legs
  • weakness that progresses rapidly
  • loss of sensation below the area of the abscess
  • paralysis below the area of the abscess
  • loss of control of your bladder and bowels
  • fever

A SCA is usually caused by the introduction of bacteria into your spinal cord. The most common bacteria that cause SCAs come from the Staphylococcus and Streptococcus species. Once these bacteria are inside your body, they may find a place to live and grow in your spinal cord. Your body sends white blood cells to fight the bacterial infection, causing pus to build up and an abscess to form.

Other possible causes of an SCA include:

  • boils that develop on your skin, especially on the skin of your back or scalp
  • septicemia, an infection of your blood that can spread to your central nervous system
  • injury caused by a foreign object, such as a bullet or knife
  • complications from back surgery or a lumbar puncture procedure
  • dermal sinus, a channel that can form between your skin and spinal canal while you’re developing in utero
  • tuberculosis

You’re at higher risk of developing an SCA if you have:

  • a history of using anticoagulant agents, or blood thinners, on a long-term basis
  • a weakened immune system, which makes it easier for bacterial infections to develop
  • Crohn’s disease, a disease that can cause lesions to form and burst in your digestive tract
  • a ruptured gallbladder
  • a habit of injecting illicit drugs

The symptoms of an SCA are often vague and may be similar to those of other conditions. As a result, it may be challenging for your doctor to diagnose an SCA. They may use multiple diagnostic tests and tools, including blood tests, imaging tests, and a lumbar puncture.

Blood tests

Your doctor may start by drawing a sample of your blood for testing in a laboratory. Technicians will check your blood for signs of infection. For example, they may assess your:

  • complete blood count (CBC)
  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein levels

Lumbar puncture

Your doctor may also collect a sample of your cerebrospinal fluid (CSF) for analysis. CSF is a clear, watery fluid that surrounds your spine and brain. It helps to cushion and protect them.

To collect a sample of your CSF, your doctor will perform a lumbar puncture, also known as a spinal tap. They will insert a needle into your spinal cavity to collect a sample of the fluid. Then they will send it to a laboratory, where technicians will check it for signs of infection.

Imaging tests

Your doctor may also use imaging technologies to examine your spine. For example, they may order:

  • X-rays
  • computed tomography (CT) scan
  • magnetic resonance imaging (MRI)

Early diagnosis and treatment is essential. If left untreated, an SCA can burst, allowing millions of bacteria spread throughout your body.

Once your doctor has located an SCA, they will have to drain or remove the abscess. For example, they may refer you to a surgeon for a laminectomy. For this procedure, you will be placed under anesthesia. Then your surgeon will open the abscess carefully and drain all of the pus and fluid inside. They’ll rinse it with sterile saline fluid to wash away remaining bacteria. If they find a dermal sinus, they will typically excise the sinus.

Your doctor will likely prescribe antibiotics too. These drugs will help kill disease-causing bacteria in your system and prevent the risk of further infection.

The dangerous potential complications of an SCA are recurrent infection, persistent pain, weakness, numbness, loss of bowel or bladder control, and even death.

It can also cause neurological symptoms and complications that persist for weeks or even years after your abscess is drained or removed. You may need neurorehabilitation to treat these symptoms.

Other complications can include dysuria and stress incontinence. Dysuria refers to difficult or painful urination. If you have stress incontinence, it’s hard to control your bladder under physical stress, such as when you’re laughing.

The earlier you get an SCA treated, the more positive your outlook. If left untreated, it can lead to more widespread infections. Early and effective treatment can help prevent the infection from getting worse and spreading. It can also help relieve your symptoms. If you have neurological symptoms that persist after your initial treatment, you may need rehabilitative therapy. It can help you regain your ability to move and function normally.

Ask your doctor for more information about your specific condition, treatment plan, and outlook.