Spinal Cord Abscess Workup

Updated: Mar 11, 2022
  • Author: Rod J Oskouian, Jr, MD; Chief Editor: Brian H Kopell, MD  more...
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Workup

Laboratory Studies

Cerebrospinal fluid (CSF) examination may show elevated protein and leukocyte levels that 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 be taken to look for parasites. Even with appropriate culture techniques, 25-40% of abscesses are microbiologically sterile.

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Imaging Studies

The procedure of choice for diagnosing a possible intramedullary spinal cord abscess is gadolinium-enhanced magnetic resonance imaging (MRI). [17, 18, 19, 20, 21]  If a high probability of spinal abnormality is present, an MRI of the area will show the mass. Magnetic resonance imaging is also valuable in demonstrating any associated disease process (eg, epidural or subdural infection, bone involvement, dermal sinus). [22]

Magnetic resonance imaging does not differentiate among types of masses (ie, between tumor and abscess), although an abscess generally demonstrates ring enhancement, and a metastatic lesion usually has 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 is enhanced 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. Diffusion-weighted imaging is useful not only for diagnosis but also for treatment planning for patients with pyogenic and nonpyogenic spinal infections. [21]

Most other diagnostic modalities are ineffectual in showing an abscess. Plain radiographs show only bony changes (if present). Myelography usually reveals widening of the spinal cord.

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