12th August 2024

Spinal infections

Spinal epidural abscess (SEA)

Infection generally results from iatrogenic introduction (via indwelling lines or catheters or surgical procedures) or contiguously from skin or soft tissue infection. In up to two thirds of cases, Staph. aureus is the culprit. Presentation is generally with a combination of severe back pain, fevers, and neurological symptoms below and at the level of the lesion.

Viral myelitis

Multiple viruses may cause disruption of spinal cord function. A transverse myelitis-like picture may be caused by herpes viruses (EBV, CMV [cytomegalovirus], HSV, VZV) or hepatitis C; a GBS-like pathology is seen with some enteroviruses (e.g. Coxsackie, polio) or flaviviruses (e.g. West Nile or Japanese encephalitis). Poliomyelitis is a rare complication of polio infection characterised by variable degrees of acute, asymmetric, progressive, flaccid muscle weakness with decreased or absent reflexes, often with a viral meningitis-like prodrome.

Tabes dorsalis

Tabes dorsalis is one of many manifestations of tertiary syphilis, with primarily dorsal column involvement. It typically presents with lancinating nerve root pain and sensory ataxia. Though onset may be decades after the original infection, treatment is still with penicillins to clear the Treponema.