• Nihal Satyadev, Colton Moore, Surpreet K Khunkhun, Kunal Aggarwal, Masha Osman, Matthew Protas, Karl Abi-Aad, Carlos R Goulart, Shawn S Rai, and Michael A Galgano.
• University of Medicine and Health Sciences, Basseterre, St. Kitts and Nevis. Electronic address: nsatyadev@umhs-sk.net.
• World Neurosurg. 2023 Jun 1; 174: 205212.e6205-212.e6.

BackgroundIntramedullary 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.ObjectiveTo 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.MethodsA 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.ResultsTwo 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).ConclusionsTreatment of ISCAs has significantly improved over the years. However, ISCAs are still poorly understood. Our recommendations can be used to guide diagnosis and treatment.Copyright © 2023 Elsevier Inc. All rights reserved.

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