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Eight Cases of Spinal Infection

In this article, physicians from the University of Siena in Italy report on eight cases of cervical spine infection. Four of the patients had a previous dental infection and two had tuberculosis. History of a recent infection is a major risk factor for spinal infection. Drug abuse is also a common factor in many spine infections.

Symptoms included fever, headache, and neck pain. The neck pain was severe and came on suddenly and rapidly. In some patients, the neck pain traveled down the arm, a condition called radiculopathy. Arm pain was often accompanied by weakness.

Early diagnosis and treatment is important to avoid permanent nerve damage. Contrast-enhanced MRI helps identify the mass as an abscess caused by infection in the epidural space. Pressure on the spinal cord shows clearly with this type of imaging. Lab values are also positive. Both the sedimentation (SED) rate and C-reactive protein (CRP) levels are elevated. These are tests to show inflammation or infection.

Surgery to drain the abscess and take pressure off the spinal cord prevents or reverses neurologic damage and speeds up recovery. The disc at the level of the abscess is removed from the front of the neck. The surgeon threads a thin tube catheter (tube) through the opening into the epidural space. Pus is removed and the area is washed clean. Fusion of the cervical spine was not needed as the neck was stable in each patient after treatment. Antibiotics were also prescribed.

Results showed reduced pain for all eight patients. Six had a complete recovery. Two others still had minor neurologic problems.

The authors conclude that spinal epidural abscess of the cervical spine is rare but serious. Anyone with a recent history of infection who develops neck pain must be evaluated and treated quickly. Without surgery to drain the abscess, the infection can spread along the spine. Patients who are immunosuppressed from other conditions such as diabetes or tuberculosis are at increased risk for this kind of problem.

References: Vitaliano Francesco Muzii, MD, et al. Cervical Spine Epidural Abscess: Experience with Microsurgical Treatment in Eight Cases. In Journal of Neurosurgery: Spine. November 2006. Vol. 5. No. 5. Pp. 392-397.

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