This blog explains the pathology of spinal abscesses, looks at the outcomes faced by patients who develop the condition, and explores the importance of making the diagnosis promptly.
Spinal abscess is a rare condition, but one which can have devastating consequences. The condition develops when an infection forms inside the spine; the body’s immune system sends white blood cells to fight the infection, which begin to fill the damaged tissue. Pus then builds up, forming an abscess. The condition is so dangerous because the abscess can sometimes compress the spinal cord, causing paralysis.
The condition may begin to develop without symptoms, but as the abscess develops it may cause severe pain, and tenderness, together sometimes with numbness and tingling. The pain may radiate to the arms and legs, and the patient’s temperature may be raised (although not in all cases). Eventually weakness will set in, and the patient may begin to lose sensation and power.
The risk of spinal abscess developing is increased by back injuries or trauma, or by boils on the skin, especially on the back or scalp. It may develop as a complication of a lumbar puncture procedure, or of spinal surgery, or by way of a spread of infection through the bloodstream from another part of the body (bacteraemia).
The usual infective organism is Staphylococcus or Streptococcus.
Suspicion should be aroused if a patient presents with the symptoms set out above, and especially with the “classic triad” of pain, tenderness and infection. Blood tests will diagnose that there is an infection (e.g. significantly raised levels of C-reactive protein), but once there is a suspicion of spinal abscess MRI scanning of the spine is mandated. Abscess can occur in the lumbar, thoracic or cervical spine.
If the MRI scan demonstrates compression of the spinal cord, urgent surgery is required to decompress the cord to prevent further damage. The abscess can also damage the spinal cord by cutting off its blood supply. The abscess needs to be drained, and this will involve removal of part of the spine. Intravenous antibiotics will also be given. If the spinal cord is not being compressed it may be appropriate to treat, in the first instance at least, with antibiotics alone.
Prognosis depends crucially on prompt diagnosis and treatment. Once the spinal cord has been compressed it is likely to be damaged, and the longer it is compressed the greater the damage is likely to be. Delay in administering antibiotics and in carrying out decompression surgery may lead to permanent paralysis, and even death. However, if the condition is diagnosed and treated promptly patients may make a full recovery.
Spinal abscess is a medical emergency, and although it is very rare, it is vital that doctors are alert to the symptoms which may suggest its presence, and are not slow to commission the MRI scan which can confirm the diagnosis.
At the Clinical Negligence Team, we have dealt with cases of delayed diagnosis of spinal abscess, where the outcome for the patient has sadly been permanent paralysis, and where prompt diagnosis and treatment would have been likely to avoid that disastrous outcome. Such cases attract damages running into millions of pounds, as the injured person is likely to need lifetime care and assistance, highlighting the importance of prompt diagnosis and treatment.