Surgical management of coccidioidomycosis of the spine

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  • Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Object

Coccidioides immitis is a dimorphous fungus endemic in the southwestern US and northern Mexico. While its primary presentation is pulmonary, it can have devastating neurological sequelae.

Methods

The authors provide a retrospective review with long-term follow-up between 1986 and 2008 at a single institution.

Results

The authors identified 27 patients between 13 and 81 years old (mean 41.4 years) with spinal coccidioides who were treated surgically at the Barrow Neurological Institute between 1986 and 2008. There were 24 males (89%) and 3 females (11%). Eleven patients (41%) had cervical spine involvement, 15 (56%) had thoracic involvement, 7 (26%) had lumbar involvement, and 2 (7%) had sacral involvement. All 27 patients presented with localized or radiating pain. Nine patients (33%) had myelopathic symptoms at presentation, 5 (19%) had radiculopathy, 4 (15%) had fever, and 12 (44%) had progressive kyphosis. The disease was most frequently seen among African American patients (14 patients [52%]), followed by Caucasians (5 patients [19%]), Asians (3 patients [11%]), and Hispanics (3 patients [11%]). Ten patients (37%) required multiple operations at the same level. Follow-up was available in 19 patients (70%) (mean 9.8 months, range 1–39 months). Sixteen (84%) of these 19 patients improved from their preoperative baseline states, 1 (5%) was stable on examination, 1 patient's condition (5%) deteriorated compared with the preoperative examination, and 1 patient (5%) died in the postoperative period.

Conclusions

Although spinal involvement of coccidioidomycosis is relatively uncommon, a high index of suspicion and aggressive therapy are warranted to prevent devastating neurological injury, and lifelong antifungal therapy is often warranted.

Abbreviation used in this paper: Oc = occiput.

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Contributor Notes

Address correspondence to: Nicholas Theodore, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@chw.edu.

Please include this information when citing this paper: published online July 8, 2011; DOI: 10.3171/2011.5.SPINE10596.

  • 1

    Adam RD, , Elliott SP, & Taljanovic MS: The spectrum and presentation of disseminated coccidioidomycosis. Am J Med 122:770777, 2009

  • 2

    Ampel NM: Coccidioidomycosis: a review of recent advances. Clin Chest Med 30:241251, v, 2009

  • 3

    Catanzaro A, , Cloud GA, , Stevens DA, , Levine BE, , Williams PL, & Johnson RH, : Safety, tolerance, and efficacy of posaconazole therapy in patients with nonmeningeal disseminated or chronic pulmonary coccidioidomycosis. Clin Infect Dis 45:562568, 2007

    • Search Google Scholar
    • Export Citation
  • 4

    Catanzaro A, , Galgiani JN, , Levine BE, , Sharkey-Mathis PK, , Fierer J, & Stevens DA, : Fluconazole in the treatment of chronic pulmonary and nonmeningeal disseminated coccidioidomycosis. Am J Med 98:249256, 1995

    • Search Google Scholar
    • Export Citation
  • 5

    Cortez KJ, , Walsh TJ, & Bennett JE: Successful treatment of coccidioidal meningitis with voriconazole. Clin Infect Dis 36:16191622, 2003

    • Search Google Scholar
    • Export Citation
  • 6

    Dalinka MK, & Greendyke WH: The spinal manifestations of coccidioidomycosis. J Can Assoc Radiol 22:9399, 1971

  • 7

    Galgiani JN, , Catanzaro A, , Cloud GA, , Johnson RH, , Williams PL, & Mirels LF, : Comparison of oral fluconazole and itraconazole for progressive, nonmeningeal coccidioidomycosis. A randomized, double-blind trial. Ann Intern Med 133:676686, 2000

    • Search Google Scholar
    • Export Citation
  • 8

    Graybill JR, , Stevens DA, , Galgiani JN, , Dismukes WE, & Cloud GA: Itraconazole treatment of coccidioidomycosis. Am J Med 89:282290, 1990

  • 9

    Homans JD, & Spencer L: Itraconazole treatment of nonmeningeal coccidioidomycosis in children: two case reports and review of the literature. Pediatr Infect Dis J 29:6567, 2010

    • Search Google Scholar
    • Export Citation
  • 10

    Lewicky YM, , Roberto RF, & Curtin SL: The unique complications of coccidioidomycosis of the spine: a detailed time line of disease progression and suppression. Spine (Phila Pa 1976) 29:E435E441, 2004

    • Search Google Scholar
    • Export Citation
  • 11

    Olson EM, , Duberg AC, , Herron LD, , Kissel P, & Smilovitz D: Coccidioidal spondylitis: MR findings in 15 patients. AJR Am J Roentgenol 171:785789, 1998

    • Search Google Scholar
    • Export Citation
  • 12

    Parish JM, & Blair JE: Coccidioidomycosis. Mayo Clin Proc 83:343349, 2008

  • 13

    Prabhu RM, , Bonnell M, , Currier BL, & Orenstein R: Successful treatment of disseminated nonmeningeal coccidioidomycosis with voriconazole. Clin Infect Dis 39:e74e77, 2004

    • Search Google Scholar
    • Export Citation
  • 14

    Proia LA, & Tenorio AR: Successful use of voriconazole for treatment of Coccidioides meningitis. Antimicrob Agents Chemother 48:2341, 2004

    • Search Google Scholar
    • Export Citation
  • 15

    Stadalnik RC, , Goldstein E, , Hoeprich PD, , dos Santos PA, & Lee KK: Diagnostic value of gallium and bone scans in evaluation of extrapulmonary coccidioidal lesions. Am Rev Respir Dis 121:673676, 1980

    • Search Google Scholar
    • Export Citation
  • 16

    Stevens DA, , Rendon A, , Gaona-Flores V, , Catanzaro A, , Anstead GM, & Pedicone L, : Posaconazole therapy for chronic refractory coccidioidomycosis. Chest 132:952958, 2007

    • Search Google Scholar
    • Export Citation
  • 17

    Wrobel CJ, , Chappell ET, & Taylor W: Clinical presentation, radiological findings, and treatment results of coccidioidomycosis involving the spine: report on 23 cases. J Neurosurg 95:1 Suppl 3339, 2001

    • Search Google Scholar
    • Export Citation

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