Surgical management of coccidioidomycosis of the spine

Clinical article

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 1. A: Magnetic resonance image obtained in an Asian American man, consistent with a 1.5-cm anterior fluid collection with extension into the superior aspect of the dens. B: Computed tomography scan revealing osteolysis of the anterior arch of C-1. C: Postfixation radiograph consistent with Oc–C3 fusion with sublaminar wiring and iliac crest autograft.

  • View in gallery

    Case 2. A: Magnetic resonance image obtained in an African American man, showing an enhancing mass and granulation tissue at the occipitocervical junction. B: A CT scan revealing diffuse osteopenia and a comminuted C-1 ring fracture. C: The patient was stabilized with an Oc–C4 fusion.

  • View in gallery

    Case 3. A: Magnetic resonance image obtained in an African American man, showing a kyphotic deformity of T10–12. B: A CT scan revealing destruction of the T10–12 vertebral bodies. C: Postoperative radiograph obtained after anterior corpectomy and T9–L1 fusion.

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