{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:34:37Z","timestamp":1789166077302,"version":"build-2803163510"},"reference-count":17,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2011,10]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p><jats:italic>Coccidioides immitis<\/jats:italic> is a dimorphous fungus endemic in the southwestern US and northern Mexico. While its primary presentation is pulmonary, it can have devastating neurological sequelae.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors provide a retrospective review with long-term follow-up between 1986 and 2008 at a single institution.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The authors identified 27 patients between 13 and 81 years old (mean 41.4 years) with spinal <jats:italic>coccidioides<\/jats:italic> who were treated surgically at the Barrow Neurological Institute between 1986 and 2008. There were 24 males (89%) and 3 females (11%). Eleven patients (41%) had cervical spine involvement, 15 (56%) had thoracic involvement, 7 (26%) had lumbar involvement, and 2 (7%) had sacral involvement. All 27 patients presented with localized or radiating pain. Nine patients (33%) had myelopathic symptoms at presentation, 5 (19%) had radiculopathy, 4 (15%) had fever, and 12 (44%) had progressive kyphosis. The disease was most frequently seen among African American patients (14 patients [52%]), followed by Caucasians (5 patients [19%]), Asians (3 patients [11%]), and Hispanics (3 patients [11%]). Ten patients (37%) required multiple operations at the same level. Follow-up was available in 19 patients (70%) (mean 9.8 months, range 1\u201339 months). Sixteen (84%) of these 19 patients improved from their preoperative baseline states, 1 (5%) was stable on examination, 1 patient's condition (5%) deteriorated compared with the preoperative examination, and 1 patient (5%) died in the postoperative period.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Although spinal involvement of coccidioidomycosis is relatively uncommon, a high index of suspicion and aggressive therapy are warranted to prevent devastating neurological injury, and lifelong antifungal therapy is often warranted.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.5.spine10596","type":"journal-article","created":{"date-parts":[[2011,7,8]],"date-time":"2011-07-08T20:28:58Z","timestamp":1310156938000},"page":"441-446","source":"Crossref","is-referenced-by-count":21,"title":["Surgical management of coccidioidomycosis of the spine"],"prefix":"10.3171","volume":"15","author":[{"given":"Udaya K.","family":"Kakarla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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