Cervical Spondylodiscitis: Presentation, Timing, and Surgical Management in 59 Patients.
Publication/Presentation Date
7-1-2017
Abstract
BACKGROUND: Cervical spondylodiscitis is thought to carry a significant risk for rapid neurologic deterioration with a poor response to nonsurgical management.
METHODS: A retrospective surgical case series of the acute surgical management of cervical spondylodiscitis is reviewed to characterize the neurologic presentation and postoperative neurologic course in a relatively uncommon disease.
RESULTS: Fifty-nine patients were identified (mean age, 59 years [range, 18-83 years; SD ± 13.2 years]) from a single-institution neurosurgical database. The most common levels of radiographic cervical involvement were C4-C5, C5-C6, and C6-C7, in descending order. Overall, statistically significant clinical improvement was noted after surgery (P < 0.05). Spinal cord hyperintensity on T2-weighted magnetic resonance imaging was significantly associated with a worse preoperative neurologic grade (P = 0.036), but did not correlate with a relatively worse neurologic outcome by discharge. No significant difference was noted between potential preoperative predictors (organism cultured, presence of epidural abscess, tobacco use, early surgery within 24 hours of clinical presentation) and preoperative American Spinal Injury Association injury scale, with the exception of the duration between symptom onset and surgical intervention. A negative correlation between increased preoperative duration of symptoms and magnitude in motor improvement was observed. Relative to anteroposterior decompression and fusion, anterior treatment alone demonstrated a relatively greater effect in neurologic improvement.
CONCLUSIONS: Cervical spondylodiscitis is a rare disease that typically manifests with preoperative motor deficits. Surgery was associated with a significant improvement in motor score by hospital discharge. Significant predictors of neurologic improvement were not observed. Prolonged symptomatic duration was correlated with a significantly lower likelihood of motor score improvement.
Volume
103
First Page
664
Last Page
670
ISSN
1878-8769
Published In/Presented At
Ghobrial, G. M., Franco, D., Theofanis, T., Margiotta, P. J., Andrews, E., Wilson, J. R., Harrop, J. S., & Heller, J. E. (2017). Cervical Spondylodiscitis: Presentation, Timing, and Surgical Management in 59 Patients. World neurosurgery, 103, 664–670. https://doi.org/10.1016/j.wneu.2017.04.119
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
28457929
Department(s)
Administration and Leadership
Document Type
Article