Departments of1Neurological Surgery.
2Radiology and Biomedical Imaging, and.
J Neurosurg Spine. 2023 May 26;39(3):419-426. doi: 10.3171/2023.4.SPINE221210. Print 2023 Sep 1.
Vertebral osteomyelitis is a rare complication of 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.
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.
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).
The duration of neurological deficits on presentation should not deter surgeons from operative intervention in cases of spinal coccidioidomycosis.
脊椎骨髓炎是球孢子菌病感染的罕见并发症。当药物治疗无效或存在神经功能缺损、硬膜外脓肿或脊柱不稳定时，需要进行手术干预。手术干预时机与神经功能恢复之间的关系尚未有报道。本研究旨在探讨初次就诊时神经功能缺损的持续时间是否影响手术干预后的神经恢复。
这是一项对 2012 年至 2021 年期间在一家三级医疗中心诊断为脊椎球孢子菌病的所有患者的回顾性研究。收集的数据包括患者的人口统计学资料、临床表现、影像学信息和手术干预。主要结果是手术干预后神经检查的变化，根据美国脊髓损伤协会损伤量表进行量化。次要结果是并发症发生率。使用逻辑回归检验神经功能缺损的持续时间是否与术后神经检查的改善相关。
2012 年至 2021 年间，27 例患者因脊椎球孢子菌病就诊；20 例患者的脊柱影像学检查显示脊椎受累，中位随访时间为 8.7 个月（IQR 1.7-71.2 个月）。20 例脊椎受累患者中有 12 例（60.0%）出现神经功能缺损，中位持续时间为 20 天（范围 1-61 天）。大多数出现神经功能缺损的患者（11/12，91.7%）接受了手术干预。11 例患者中有 9 例（81.2%）手术后神经检查改善，另外 2 例神经缺损稳定。7 例患者的恢复程度足以根据 AIS 提高 1 个等级。初次就诊时神经功能缺损的持续时间与手术后神经功能改善无显著相关性（p = 0.49，Fisher 确切检验）。
在脊椎球孢子菌病的情况下，初次就诊时神经功能缺损的持续时间不应阻止外科医生进行手术干预。
