Spinal Intramedullary Abscess Secondary to Dermal Sinus in Children

Abstract

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.

Spinal Abscess in a Patient with Undiagnosed Congenital Dermal Sinus Tract

“…3,8,9 Presenting symptoms are usually non-specific and include fever, meningismus, acute neurological deficit, and bladder incontinence. 10,11 Some children can have purulent drainage of fluid from the ostium of the DST which can suggest an underlying infection. Causative organisms isolated from spinal abscesses have been Staphylococcus spp., Streptococcus spp., E. coli, Actinomyces spp., Pneumococcus spp, and Proteus.…”

“…Hence, in the current era, MRI is considered to be the modality of choice as it provides detailed soft-tissue differentiation, reconstruction across different planes, ability to delineate spinous structures accurately, and no radiation risks. 10 The mainstay of treatment is usually a combination of intravenous antibiotics along with surgery. Intravenous antibiotics were mostly used for at least 4 to 6 weeks.…”

“…Microbiological pathogens may not be isolated in all cases and approximately 30% have sterile cultures which could be due to prior antibiotic treatment or chemical meningitis from the overlying dermoid cyst fluid. 9 - 12 Ultrasound has low sensitivity in detecting dermal sinus tracts and it mainly depends on the expertise of the radiologist performing it. Unfortunately, in our patient, ultrasound was unable to detect the dermal sinus tract and thus lumbar puncture was attempted.…”

“…Hence, in the current era, MRI is considered to be the modality of choice as it provides detailed soft-tissue differentiation, reconstruction across different planes, ability to delineate spinous structures accurately, and no radiation risks. 10 …”

“…Timing of the surgery has been equivocal as some authors recommended immediate surgical drainage at diagnosis whereas others recommended initial control of infection with antibiotics followed by surgical drainage and repair of DST later. 9 , 10 , 12 However, recent review articles have consistently shown better neurological outcomes with early surgical intervention before the development of infection. 9 - 11 Neurological deficits in these children could either be due to underlying neurological malformation or spinal abscess causing vascular compromise and local mechanical pressure.…”