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Duration of neurological deficit and outcomes in the surgical treatment of spinal coccidioidomycosis

Alexa Semonche Departments ofNeurological Surgery,

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Justin K. Scheer Departments ofNeurological Surgery,

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Vinil N. Shah Radiology and Biomedical Imaging, and

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Monica Fung Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California

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Lee A. Tan Departments ofNeurological Surgery,

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Dean Chou Departments ofNeurological Surgery,

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Praveen V. Mummaneni Departments ofNeurological Surgery,

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Sigurd H. Berven Orthopaedic Surgery, University of California, San Francisco; and

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Christopher P. Ames Departments ofNeurological Surgery,

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Vedat Deviren Orthopaedic Surgery, University of California, San Francisco; and

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Alekos A. Theologis Orthopaedic Surgery, University of California, San Francisco; and

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Aaron J. Clark Departments ofNeurological Surgery,

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MD, PhD
Publication Date:
26 May 2023
Page Range:
1–8
Volume/Issue:
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DOI link:
https://doi.org/10.3171/2023.4.SPINE221210
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OBJECTIVE

椎体骨髓炎是一种罕见的并发症coccidioidomycosis infection. Surgical intervention is indicated when there is failure of medical management or presence of neurological deficit, epidural abscess, or spinal instability. The relationship between timing of surgical intervention and recovery of neurological function has not been previously described. The purpose of this study was to investigate if the duration of neurological deficits at presentation affects neurological recovery after surgical intervention.

开云体育世界杯赔率

This was a retrospective study of all patients diagnosed with coccidioidomycosis involving the spine at a single tertiary care center between 2012 and 2021. Data collected included patient demographics, clinical presentation, radiographic information, and surgical intervention. The primary outcome was change in neurological examination after surgical intervention, quantified according to the American Spinal Injury Association Impairment Scale. The secondary outcome was the complication rate. Logistic regression was used to test if the duration of neurological deficits was associated with improvement in the neurological examination after surgery.

RESULTS

Twenty-seven patients presented with spinal coccidioidomycosis between 2012 and 2021; 20 of these patients had vertebral involvement on spinal imaging with a median follow-up of 8.7 months (IQR 1.7–71.2 months). Of the 20 patients with vertebral involvement, 12 (60.0%) presented with a neurological deficit with a median duration of 20 days (range 1–61 days). Most patients presenting with neurological deficit (11/12, 91.7%) underwent surgical intervention. Nine (81.2%) of these 11 patients had an improved neurological examination after surgery and the other 2 had stable deficits. Seven patients had improved recovery sufficient to improve by 1 grade according to the AIS. The duration of neurological deficits on presentation was not significantly associated with neurological improvement after surgery (p = 0.49, Fisher’s exact test).

CONCLUSIONS

神经赤字的持续时间s on presentation should not deter surgeons from operative intervention in cases of spinal coccidioidomycosis.

ABBREVIATIONS

AIS = American Spinal Injury Association Impairment Scale .
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Contributor Notes

CorrespondenceAlexa Semonche: University of California, San Francisco, CA.alexa.semonche@ucsf.edu.

INCLUDE WHEN CITINGPublished online May 26, 2023; DOI: 10.3171/2023.4.SPINE221210.

DisclosuresDr. Tan reported being a consultant for Medtronic and Stryker. Dr. Chou reported personal fees from Orthofix and Globus, outside the submitted work. Dr. Mummaneni reported personal fees from DePuy Synthes, NuVasive, Globus, Stryker, Brainlab, Thieme Publishers, and Springer Publishers; grants from AO Spine, NREF, and ISSG; and direct sock ownership in Spinicity/ISD, outside the submitted work. Dr. Berven reported personal fees from Medtronic, Stryker, Camber, Accelus, and Globus, outside the submitted work. Dr. Ames reported royalties from Stryker, Biomet Zimmer Spine, DePuy Synthes, NuVasive, Next Orthosurgical, K2M, and Medicrea; being a consultant for DePuy Synthes, Medtronic, Medicrea, K2M, Agada Medical, and Carlsmed; research funding from Titan Spine, DePuy Synthes, and ISSG; being on the editorial boards of Operative Neurosurgery and Neurospine; grants from SRS; executive board of ISSG; being director of Global Spinal Analytics; and chair of SRS Safety and Value, outside the submitted work. Dr. Deviren reported being a consultant for Atex, Medicrea, NuVasive, and Medtronic; fellowship grant from NuVasive, Medtronic, OMega, and AO Spine; and royalties from NuVasive, outside the submitted work. Dr. Theologis reported being a consultant for DePuy Spine, Ulrich, Restor3D, Icotec, Surgalign, and Carbofix; royalties from Alphatec; and advisory board member for Ulrich and Restor3D, outside the submitted work. Dr. Clark reported being a consultant for NuVasive, Alphatec, and Carlsmed.
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