title: Treatment of coccidioidal spinal infection: experience in 16 cases.
abstract: Sixteen patients with spinal infection from Coccidioides immitis were treated. Lesion location was cervical in two, thoracic in four, lumbar in six, sacroiliac joint in one, and disseminated spinal in three. The neurological status was intact in 11 patients. One patient had incomplete quadriplegia, three patients had incomplete paraplegia, and a fifth patient had a lumbar root lesion. Treatment was medical only in 4 patients (one of whom required surgery 2 years later) and combined medical and surgical in 13 patients. All patients received amphotericin B intravenously. Follow-up averaged 24 months in 15 patients (range, 12-42 months). The outcome in four patients treated medically alone was one death, one remission, one relapse with disease progression, and one without follow-up. The outcome in the combined medical and surgical group was nine fusions, one pseudarthrosis, and three lesional excisions, all with remission. Successful treatment outcome is disease arrest, as opposed to "cure."
authors.affiliation: Central Coast Spine Institute, San Luis Obispo, CA 93405, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Herron
authors.forename: P
authors.initials: P
authors.lastname: Kissel
authors.forename: D
authors.initials: D
authors.lastname: Smilovitz
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D002574:Cervical Vertebrae; D003047:Coccidioidomycosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003646:Debridement; D015299:Discitis / Q000188:drug therapy / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae; D008172:Lung Diseases, Fungal / Q000150:complications / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications; D011329:Prisoners; D011782:Quadriplegia / Q000209:etiology; D012074:Remission Induction; D012272:Ribs / Q000601:surgery; D012446:Sacroiliac Joint; D013123:Spinal Fusion; D013126:Spinal Nerve Roots; D013166:Spondylitis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B