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Intramedullary Spinal Cord Abscess Management: Case Series, Operative Video, and Systematic Review
Nihal Satyadev1, Colton Moore2, Surpreet K Khunkhun1
1University of Medicine and Health Sciences, Basseterre, St. Kitts and Nevis.
Background:
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.
Objective:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
Insights
Intramedullary spinal cord abscess (ISCA) is rare, but age and antibiotic use significantly impact outcomes. This study reviews cases to improve diagnosis and treatment strategies for this challenging condition.
Area of Science:
- Neurosurgery
- Neurology
- Infectious Diseases
Background:
- Intramedullary spinal cord abscess (ISCA) is an extremely rare condition with limited evidence-based treatment guidelines.
- Fewer than 250 cases have been reported since 1830, hindering comprehensive understanding and management.
- The low evidence level (Level V) poses challenges for surgical characterization and treatment planning.
Approach:
- A systematic literature review of MEDLINE and Embase databases was performed using keywords: "intramedullary," "spinal cord," "abscess," and "tuberculoma."
- Two hundred case reports of ISCA diagnosed between 1965 and 2022 were identified and analyzed.
- Logistic regression analysis was conducted 100 times to identify significant predictors of outcomes.
Key Points:
- Analysis of 200 ISCA cases revealed age (P < 0.01) and antibiotic treatment (P < 0.05) as statistically significant variables.
- The study highlights the importance of patient demographics and therapeutic interventions in managing ISCA.
- Surgical management of ISCA has evolved, but understanding remains limited.
Conclusions:
- Despite treatment advancements, intramedullary spinal cord abscesses remain poorly understood.
- The findings provide a basis for improved diagnostic and therapeutic recommendations.
- Further research is warranted to enhance the management of this rare neurological condition.
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