Spinal Cord Infection
Infections of the spinal cord and surrounding structures can lead to severe neurological damage and require urgent diagnosis and treatment.
1. Definition
Spinal cord infections refer to inflammatory or infectious processes affecting the spinal cord, meninges, or epidural/subdural spaces.
2. Classification by Type
- Myelitis (intramedullary) – Inflammation/infection of the spinal cord parenchyma itself
_Examples: viral transverse myelitis, post-infectious myelitis_
- Spinal Epidural Abscess (SEA) – Purulent collection in the epidural space, often compressive
_Common agents: Staphylococcus aureus, Streptococci_
- Spinal Subdural Empyema – Rare infection between dura and arachnoid
- Infectious Arachnoiditis – Chronic inflammation of arachnoid due to TB, syphilis, or post-surgical infection
- Vertebral Osteomyelitis/Discitis – Infection of vertebral bodies or discs that may spread to the spinal canal
3. Etiology
| Type | Common Pathogens / Causes |
|---|---|
| Bacterial | Staphylococcus aureus, Mycobacterium tuberculosis |
| Viral | Herpes viruses, Enteroviruses, HTLV-1 |
| Fungal | Candida, Aspergillus, Histoplasma |
| Parasitic | Schistosoma, Cysticercosis |
| Post-surgical / iatrogenic | Instrumentation, spinal injections |
4. Clinical Features
- Fever, back pain, and rapidly progressive neurological deficit (e.g. weakness, sensory level, bladder dysfunction)
- Radicular pain in infectious arachnoiditis
- Possible signs of spinal cord compression
5. Diagnosis
- MRI with contrast – Gold standard for evaluating spinal infections
- CSF analysis – In cases of myelitis
- Blood cultures – Identify systemic spread
- Biopsy or aspiration – In abscesses or unclear cases
6. Treatment
- Empiric IV antibiotics, then tailored to culture results
- SEA: Vancomycin + 3rd-gen cephalosporin
- Corticosteroids – Controversial, sometimes used in myelitis
- Surgical decompression if spinal cord compression or abscess
- Antivirals or antifungals as indicated
- Antituberculous therapy for TB-related infections
Summary Table
| Condition | Imaging Finding | Treatment |
|---|---|---|
| Epidural Abscess | Rim-enhancing lesion in epidural space | Surgical drainage + IV antibiotics |
| Transverse Myelitis | Long segment T2 hyperintensity in cord | Antivirals, corticosteroids |
| Infectious Arachnoiditis | Clumped nerve roots in thecal sac | Anti-TB or anti-syphilis therapy |
| Discitis/Osteomyelitis | Disc space narrowing + endplate changes | IV antibiotics ± surgery |
Notes
- Delayed treatment can lead to irreversible paraplegia.
- Always rule out coexistent infections (e.g., endocarditis).
- Close follow-up with serial MRI and inflammatory markers is essential.