Kinetics of Regression of Sciatica and Pain in the Low Back After Lumbar Macrodiscectomy in Human Immunodeficiency Virus Carriers

Eyenga, Victor; Ngowe, NM; Minkande, Jacqueline Zé; Ngah, Joseph Eloundou

doi:10.1097/brs.0b013e318175c32b

Cited by 7 publications

(12 citation statements)

References 12 publications

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“…Eyenga and coworkers reported no complications after lumbar discectomy in nine HIV positive patients, improved sciatica symptoms in eight patients (89%) at three months follow-up, and no differences in outcomes when compared to a contemporaneous group of 68 uninfected patients undergoing the same procedure. 6 Young et al described improvement in five patients after surgery for degenerative spine disease with two minor complications (superficial infection, spontaneously resolving postoperative fever). 5 Larger studies are required to accurately establish the outcomes of elective spine surgery for degenerative spine disease in HIV infected patients.…”

Section: Discussionmentioning

confidence: 99%

“…Spine surgery for degenerative spine disease has become increasingly common in the United States 3;4 and is the subject of numerous academic publications, yet there are few publications describing outcomes of spine surgery for degenerative disease in HIV infected individuals. 5;6 The low United States population prevalence of HIV infection (estimated at 0.4%) 7 complicates the study of surgical procedures in HIV positive patients – single institutions or even consortia may have insufficient numbers of HIV infected surgical patients to power meaningful analyses.…”

Section: Introductionmentioning

confidence: 99%

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Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV-Infected and Uninfected Veterans

King

Gordon²,

Perkal³

et al. 2012

Spine

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Study Design Retrospective analysis of nationwide Veterans Health Administration (VA) clinical and administrative data. Objective Examine the association between HIV infection and the rate of spine surgery for degenerative spine disease. Summary of Background Data Combination anti-retroviral therapy (cART) has prolonged survival in patients with HIV/AIDS, increasing the prevalence of chronic conditions such as degenerative spine disease that may require spine surgery. Methods We studied all HIV infected patients under care in the VA from 1996–2008 (n=40,038) and uninfected comparator patients (n=79,039) matched on age, gender, race, year, and geographic region. The primary outcome was spine surgery for degenerative spine disease defined by ICD-9 procedure and diagnosis codes. We used a multivariate Poisson regression to model spine surgery rates by HIV infection status, adjusting for factors that might affect suitability for surgery (demographics, year, comorbidities, body mass index, cART, and laboratory values). Results Two-hundred twenty eight HIV infected and 784 uninfected patients underwent spine surgery for degenerative spine disease during 700,731 patient-years of follow-up (1.44 surgeries per 1,000 patient-years). The most common procedures were spinal decompression (50%), and decompression and fusion (33%); the most common surgical sites were the lumbosacral (50%), and cervical (40%) spine. Adjusted rates of surgery were lower for HIV infected patients (0.86 per 1,000 patient-years of follow-up) than for uninfected patients (1.41 per 1,000 patient-years; IRR 0.61, 95% CI: 0.51, 0.74, P<0.001). Among HIV infected patients, there was a trend towards lower rates of spine surgery in patients with detectable viral loads levels (IRR 0.76, 95% CI: 0.55, 1.05, P=0.099). Conclusion In the VA, HIV infected patients experience significantly reduced rates of surgery for degenerative spine disease. Possible explanations include disease prevalence, emphasis on treatment of non-spine HIV-related symptoms, surgical referral patterns, impact of HIV on surgery risk-benefit ratio, patient preferences, and surgeon bias.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV-Infected and Uninfected Veterans

King

Gordon²,

Perkal³

et al. 2012

Spine

View full text Add to dashboard Cite

show abstract

“…22 There were no significant differences in sciatica or low back pain after surgery between HIV-positive and HIVnegative patients. 22…”

Section: Surgical Outcomesmentioning

confidence: 82%

HIV and Surgery for Degenerative Spine Disease: A Systematic Review

Farias

Dagostini

Falavigna

2021

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims The objective of this review is to evaluate the incidence of operative treatment, outcomes, and complications of surgery for degenerative spine disease (DSD) on human immunodeficiency virus (HIV) positive patients. Combined antiretroviral treatment led HIV patients to live long enough to develop many chronic conditions common in the uninfected population. Surgery for DSD is one of the most commonly performed neurosurgical procedures. However, the incidence of spine surgery for DSD in HIV-positive patients seems to be lower than that in uninfected individuals, although this has not been clearly determined. Methods A systematic search of the Medline, Web of Science, Embase, and SciElo databases was conducted. Only primary studies addressing DSD surgery on HIV-positive patients were included. Evaluated variables were rates of surgical treatment, surgical outcomes and complications, year of publication, country where study was conducted, type of study, and level of evidence. Results Six articles were included in the review from 1,108 records. Significantly lower rates of DSD surgery were identified in HIV-infected patients (0.86 per 1,000 patient-years) when compared with uninfected patients (1.41 per 1,000 patient-years). There was a significant increase in spinal surgery in HIV-positive patients over time, with a 0.094 incidence per 100,000 in the year 2000 and 0.303 in 2009. HIV-positive patients had very similar outcomes when compared with controls, with 66.6% presenting pain relief at a 3-month follow-up. Higher incidences of hospital mortality (1.6 vs. 0.3%; p < 0.001) and complications (12.2 vs. 9.5%, p < 0.001) were observed in HIV carriers. Conclusions HIV-positive individuals appear to undergo less surgery for DSD than HIV-negative individuals. Improvement rates appear to be similar in both groups, even though some complications appear to be more prevalent in HIV carriers. Larger studies are needed for decisive evidence on the subject.

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“…In the case of lumbar disk herniation causing CES in HIV-positive patients, surgery is considered more effective than medical management in the short term [ 26 ]. In the single relevant study, no significant difference in the response of HIV-infected individuals to surgical treatment of lumbar disk herniation was found, as compared to uninfected patients [ 27 ]. It is estimated that 1–3 % of all patients with intervertebral lumbar disc herniation may manifest with CES [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Differential diagnosis and treatment of acute cauda equina syndrome in the human immunodeficiency virus positive patient: a case report and review of the literature

et al. 2016

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BackgroundAcute cauda equina syndrome is an uncommon but significant neurologic presentation due to a variety of underlying diseases. Anatomical compression of nerve roots, usually by a lumbar disk hernia is a common cause in the general population, while inflammatory, neoplastic, and ischemic causes have also been recognized. Among human immunodeficiency virus (HIV) infected patients with acquired immunodeficiency syndrome, infectious causes are encountered more frequently, the most prevalent of which are: cytomegalovirus, herpes simplex virus 1/2, varicella zoster virus, and Mycobacterium tuberculosis infections. Studies of cauda equina syndrome in well-controlled HIV infection are lacking. We describe such a case of cauda equina syndrome in a well-controlled HIV-infected patient, along with a brief review of the literature regarding the syndrome’s diagnosis and treatment in individuals with HIV infection.Case presentationA 36-year-old Greek male, HIV-positive patient presented with perineal and left hemiscrotal numbness, lumbar pain, left-sided sciatica, and urinary incontinence. Magnetic resonance imaging of the patient’s lumbar spine revealed intrathecal migration of a fragment from an intervertebral lumbar disk exerting pressure on the cauda equina. A cerebrospinal fluid examination, brain computed tomography scan, spine magnetic resonance imaging, and serological test results were negative for central nervous system infections. Our patient underwent emergency neurosurgical spinal decompression, which resolved most symptoms, except for mild urinary incontinence.ConclusionsNoninfectious etiologies may also cause cauda equina syndrome in HIV-infected individuals, especially in well-controlled disease under antiretroviral therapy. Prompt recognition and treatment of the underlying cause is important to minimize residual symptoms. Targeted antimicrobial chemotherapy is used to treat infectious causes, while prompt surgical decompression is favored for anatomical causes of cauda equina syndrome in the HIV-infected patient.

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Kinetics of Regression of Sciatica and Pain in the Low Back After Lumbar Macrodiscectomy in Human Immunodeficiency Virus Carriers

Cited by 7 publications

References 12 publications

Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV-Infected and Uninfected Veterans

Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV-Infected and Uninfected Veterans

HIV and Surgery for Degenerative Spine Disease: A Systematic Review

Differential diagnosis and treatment of acute cauda equina syndrome in the human immunodeficiency virus positive patient: a case report and review of the literature

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