Factors related to post surgical neurologic improvement for cervical spine infection

Abstract

BackgroundCervical spine infections are uncommon but potentially dangerous, having the highest rate of neurological compromise and resulting disability. However, the factors related to surgical success is multiple yet unclear.MethodsWe retrospectively reviewed the medical records of 27 patients (16 men and 11 women) with cervical spine infection who underwent surgical treatment at Chang Gung Memorial Hospital, Linkou branch, between 2001 and 2014. The neurological status, by Frankel classification, was recorded preoperatively and at discharge. Group X had neurologic improvement of at least 1 grade, group Y had unchanged neurologic status, and group Z showed deterioration. We recorded the patient demographic data, presenting symptoms and signs, interval from admission to surgery, surgical procedure, laboratory data, perioperative antibiotic course, pathogens identified, coexisting medical disease, concomitant nonspinal infection, and clinical outcomes. We intended to evaluate the different characteristics of patients who improved neurologically after treatment.ResultsThe mean age of our cohort was 56.6 years. Anterior cervical discectomy and fusion was the most commonly performed surgical procedure (74.1%). The Frankel neurological status improved in 70.4% (group X, n = 19) and unchanged in 29.6% (group Y, n = 8). No patients worsened. Motor weakness was most common (96.3%) neurological deficit, followed by sensory abnormalities (37.0%), and bowel/urine incontinence (33.3%). The main difference in presentation between group X and group Y was neck pain (100% vs. 75.0%; p = .02), not fever. Group X had a shorter preoperative antibiotic course (p = .004), interval from admission to operation (p = .02), and hospital stay (p = .01).ConclusionClinicians should be more suspicious in patients who present with neck pain and any neurological involvement even in those without fever while establishing early diagnosis. Earlier operative treatment in group X result in better neurologic recovery and shorter hospital stay due to disease improvement.

The pre-surgical role of halo-traction in patients with cervical infection associated with refractory kyphosis. A retrospective study

“…Complications including cervical kyphosis, loss of range of motion, spinal cord compression, nerve route compression, neurological de cits have been reported. Therefore surgical treatment of cervical infections do focus much on constructing the vertebral height, restoration of cervical lordosis and biomechanics, lowering the impact on the adjacent vertebral and interverbral disc (17).…”

Dengue in Taiwan: Pointing the finger at Aedes aegypti

“…In this retrospective analysis of 27 patients, Luo et al. [19] find that those patients who underwent surgery quickly after being admitted to hospital showed a better neurological outcome. In addition, patients with neck pain before surgery showed poorer neurological improvements, suggesting that clinicians should pay close attention to this symptom when establishing a diagnosis and treatment plan.…”

Incidence, risk factors and clinical course of pyogenic spondylodiscitis patients with pulmonary embolism

“…The primary site of infection is the avascular disc, the infection may then spread continually into the vertebral body and up into the subligamentous paravertebral area, epidural space and contiguous vertebral bodies. In consequence, back pain and limitation of spine movement are the predominant signs in patients with spondylodiscitis [ 4 , 5 ]. Treatment concepts of pyogenic spondylodiscitis include either a conservative or a surgical management and should be evaluated individually.…”

“…The conservative treatment consists of germ-compatible long-term antibiotic treatment and immobilisation of the spine [ 5 , 9 ]. In patients with progressive neurologic deficits, large abscesses, progressive deformities or involvement of at least two adjacent vertebral bodies, surgical management should be favoured [ 10 ].…”