TY - JOUR
T1 - Factors related to post surgical neurologic improvement for cervical spine infection
AU - Luo, Chi An
AU - Tsai, Tsung Ting
AU - Lu, Meng Ling
AU - Hsieh, Ming Kai
AU - Lai, Po Liang
AU - Fu, Tsai Sheng
AU - Chen, Wen Jer
AU - Chen, Lih Huei
AU - Niu, Chi Chien
N1 - Publisher Copyright:
© 2018 Chang Gung University
PY - 2018/10
Y1 - 2018/10
N2 - Background: Cervical 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. Methods: We 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. Results: The 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). Conclusion: Clinicians 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.
AB - Background: Cervical 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. Methods: We 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. Results: The 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). Conclusion: Clinicians 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.
KW - Epidural abscess
KW - Neurologic manifestation
KW - Osteomyelitis
KW - Risk factors
KW - Spondylodiscitis
UR - http://www.scopus.com/inward/record.url?scp=85055983662&partnerID=8YFLogxK
U2 - 10.1016/j.bj.2018.07.004
DO - 10.1016/j.bj.2018.07.004
M3 - 文章
C2 - 30580794
AN - SCOPUS:85055983662
SN - 2319-4170
VL - 41
SP - 306
EP - 313
JO - Biomedical Journal
JF - Biomedical Journal
IS - 5
ER -