Intramedullary Spinal Cord Abscess Management: Case Series, Operative Video, and Systematic Review

Intramedullary spinal cord abscess (ISCA) is an extremely rare disease, which has had fewer than 250 reported cases since its initial description in 1830. The condition is limited to level V evidence, limiting the ability for surgeons to characterize and treat it. To report the cases of 2 patients w...

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Bibliographic Details
Published in:World neurosurgery 2023-06, Vol.174, p.205-212.e6
Main Authors: Satyadev, Nihal, Moore, Colton, Khunkhun, Surpreet K., Aggarwal, Kunal, Osman, Masha, Protas, Matthew, Abi-aad, Karl, Goulart, Carlos R., Rai, Shawn S., Galgano, Michael A.
Format: Article
Language:English
Subjects:
Abscess
Abscess - diagnostic imaging
Abscess - surgery
Anti-Bacterial Agents - therapeutic use
Case series
Female
Humans
Intramedullary
Laminectomy - methods
Magnetic Resonance Imaging
Male
Middle Aged
Spinal cord
Spinal Cord - surgery
Spinal Cord Diseases - diagnostic imaging
Spinal Cord Diseases - surgery
Spine
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Summary:Intramedullary spinal cord abscess (ISCA) is an extremely rare disease, which has had fewer than 250 reported cases since its initial description in 1830. The condition is limited to level V evidence, limiting the ability for surgeons to characterize and treat it. To report the cases of 2 patients with ISCA and their surgical management: a 59-year-old woman who presented with progressive right hemiparesis and a 69-old man who presented with acute gait instability and significant bilateral shoulder pain. In addition, to report findings from a systematic literature review and associated logistic regression analysis. A MEDLINE and Embase search was conducted using the keywords “intramedullary,” “spinal cord,” “abscess,” and “tuberculoma” and the results were screened for case reports. A logistic regression model was fit 100 times on data to retrieve predictor odds ratios. Two hundred case reports of ISCA were identified between 1965 and 2022. Logistic regression determined that the only variables of significance were age (P < 0.01) and antibiotics (P < 0.05). Treatment of ISCAs has significantly improved over the years. However, ISCAs are still poorly understood. Our recommendations can be used to guide diagnosis and treatment.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2023.03.013