Update: Intramedullary spinal cord abscess

Intramedullary spinal cord abscess

Intramedullary spinal cord abscess due to congenital dermal sinus (CDS) is rare and often co-exists with an inclusion tumor such as dermoid/epidermoid cyst.

CDS are the commonest cause of intramedullary spinal cord abscess (IMSCA) 1).

Prasad et al. did a literature review to analyze all cases of pediatric IMSCA secondary to CDS by searching online databases starting from the oldest case reported.

Only 50 cases have been reported and were analyzed. Mean age was 22.6 months (range 1 month-15 years). Fever, acute flaccid lower limbweakness, and urinary disturbances were the most common presenting features. Dermal sinus was commonest in lumbosacral region. Inclusion cysts were observed in 50% of cases. Staphylococcus aureus was the most the common organism. Mean follow-up duration was 18.2 months (range 1 week-156 months). Majority of the cases underwent multilevel laminectomy with myelotomy and drainage of abscess. Outcome was good-to-excellent in around 60% cases with four deaths. Presence of fever and limb weakness was significantly associated with poor outcomes.

Intramedullary abscess secondary to CDS is very rare. Complete sinus tract excision, myelotomy and drainage of abscess, and decompression of co-existent inclusion cysts with prolonged antibiotic therapy remain the standard treatment. Approximately 60% cases achieve good outcomes. Fever and limb weakness portend poorer outcomes than those without 2).

1)

Kanaheswari Y, Lai C, Raja Lope RJ, Azizi AB, Zulfiqar MA. Intramedullary spinal cord abscess: The result of a missed congenital dermal sinus. J Paediatr Child Health. 2014 Aug 7. doi: 10.1111/jpc.12707. [Epub ahead of print] PubMed PMID: 25099316.

2)

Prasad GL, Hegde A, Divya S. Spinal Intramedullary Abscess Secondary to Dermal Sinus in Children. Eur J Pediatr Surg. 2018 Jun 1. doi: 10.1055/s-0038-1655736. [Epub ahead of print] PubMed PMID: 29857348.

Leave a Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Whatsapp us