Chapter 16: Spinal Cord Injury: Infectious and Inflammatory Etiologies

INTRODUCTION

In most high-resource countries, the three most common etiologies of non-traumatic spinal cord injury (NTSCI) include SCI caused by tumors, degenerative conditions of the spine, and vascular etiologies. In contrast, in many low-resource countries that have high levels of tuberculosis and other infectious diseases such as HIV, infectious causes are more common than degenerative and vascular etiologies.¹ Given the paucity and variability in what conditions are reported in studies of the incidence of NTSCI, the overall incidence of infectious and inflammatory causes cannot be estimated with any confidence.

NTSCI typically presents with findings similar to those seen with traumatic SCI (TSCI), specifically weakness and sensory changes below the neurologic level of injury, often accompanied by bowel and bladder or other autonomic impairments. NTSCI can also result in the same types of secondary medical complications as TSCI, including but not limited to, deep vein thrombosis, pressure ulcers, autonomic dysreflexia, pneumonia, orthostatic hypotension, spasticity, heterotopic ossification, pain, and sexual dysfunction.

This chapter will address the most common infectious and inflammatory etiologies of NTSCI seen in high-resource countries. (See Chapter 15 for myelopathies and motor neuron diseases and Chapter 17 for neoplasms). As there is widespread availability of magnetic resonance imaging (MRI) and computed tomography (CT) in high-resource countries, compressive etiologies can be easily excluded. However, since the differential diagnosis of NTSCI also includes infectious, toxic, nutritional, vascular, systemic, and paraneoplastic as well as inflammatory etiologies, many of which present similarly clinically, differentiating among these other causes of NTSCI (see Table 16–1) can be difficult and time consuming. In addition to performing a thorough history and physical examination and obtaining the requisite imaging studies, obtaining spinal fluid analysis and serological studies often is essential to make a definitive diagnosis.