Cervical Spondylodiscitis: Presentation, Timing, and Surgical Management in 59 Patients.

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Cervical Spondylodiscitis: Presentation, Timing, and Surgical Management in 59 Patients.

World Neurosurg. 2017 Apr 27;:

Authors: Ghobrial GM, Franco D, Theofanis T, Margiotta PJ, Andrews E, Wilson J, Harrop JS, Heller JE

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: 59 patients were identified (mean age 59 yrs, range 18-83yrs, SD ±13.2yrs) from a single-institution neurosurgical database. The most common level of radiographic cervical involvement was C4-C5, C5-C6, and C6-C7, in descending order. Overall, statistically significant clinical improvement was noted following surgery (p<0.05). MRI T2-weighted spinal cord hyperintensity 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 AIS exam score 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-alone treatment demonstrated a relatively greater impact in neurologic improvement.
CONCLUSIONS: Cervical spondylodiscitis is a rare disease, typically presenting 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.

PMID: 28457929 [PubMed - as supplied by publisher]

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