Resident Physician University of California San Francisco San Francisco, California, United States
Introduction: Vertebral osteomyelitis is a rare complication of coccidioidomycosis infection. Surgical intervention is indicated when there is failure of medical management, presence of neurologic deficit, epidural abscess, or spinal instability. The relationship between timing of surgical intervention and recovery of neurologic function has not been previously described. The purpose of this paper is to investigate if the duration of neurologic deficit on presentation affects neurological recovery after surgical intervention.
Methods: Retrospective study of all patients diagnosed with coccidioidomycosis involving the spine at a single tertiary care center between 2012-2021. Data collected included patient demographics, clinical presentation, radiographic information, and surgical intervention. The primary outcome was change in neurological exam after surgical intervention. Secondary outcome included complication rate. Logistic regression was used to test if duration of neurological deficit was associated with improvement in neurologic exam after surgery.
Results: Twenty-seven patients presented with spinal coccidiomycosis between 2012-2021; twenty had vertebral involvement on spinal imaging with a mean follow up of 10.5 months (range 0.3-55.6 months). Of 20 patients with vertebral involvement, 12 (60.0%) presented with a neurological deficit with a median duration of 20 days (range 1-61). Most patients presenting with neurologic deficit (11 of 12, 91.7%) underwent surgical intervention. Nine of these 11 patients (81.2%) had an improved neurologic exam after surgery; the other 2 had stable deficits. Seven patients improved 1 ASIA grade compared to initial presentation. The remaining 5 patients remained at their preoperative ASIA classification (3 of these patients did have some degree of neurologic improvement, but not enough to change their ASIA categorization). Duration of neurologic deficit on presentation was not significantly associated with neurologic improvement after surgery (p=0.18, logistic regression analysis; odds ratio=6.7 [95% confidence interval=0.6-267.4]).
Conclusion : Duration of neurological deficit should not deter surgeons from operative intervention in cases of spinal coccidioidomycosis with a neurological deficit on presentation.
