One-stage posterior surgery in the treatment of lumbar Brucella spondylitis
GAO Jie
LAN Xu
LI Zhi-lin
YANG Cheng-wei
DOU Qiang
ZHEN Ping
Abstract：Objective To investigate the curative effect of one-stage posterior debridement, interbody fusion with iliac autograft and pedicle screw internal ifxation in the treatment of lumbar Brucella spondylitis.Methods Twelve patients with lumbar Brucella spondylitis adopted from March 2011 to December 2013 were treated with one-stage posterior debridement, interbody fusion with iliac autograft and pedicle screw internal ifxation, whose clinical data were analyzed retrospectively. There were 8 males and 4 females, whose mean age was ( 43.8 ± 11.1 ) years ( range: 22 - 62 years ). All the patients had contact history with sick sheep or had eaten them. C-reactive protein ( CRP ), erythrocyte sedimentation rate ( ESR ), MRI, CT, rose bengal plate agglutination test ( RBPT ) and standard tube agglutination test ( SAT ) examinations were performed for diagnosis preoperatively. At 2 weeks after combined chemotherapy comprised of streptomycin, doxycycline and rifampicin, the patients were treated with posterior debridement, interbody fusion with iliac autograft and pedicle screw internal fixation, followed by continuous chemotherapy for 3 months. Infectious indicators were reviewed dynamically until negative results were noticed by SAT, which still continued for 2 weeks. The visual analogue scale ( VAS ) was used to evaluate relief of low back pain and lower limb pain, and the American spinal injury association ( ASIA ) classiifcation was performed to assess nerve function recovery.Results The operation time was 150 - 220 min ( mean 179.3 ± 22.6 min ), and the amount of bleeding was 200 - 450 ml ( mean 288.3 ± 79.9 ml ). No large blood vessel or spinal cord injuries were found during theoperation, and all the wounds healed in grade A. During the follow-up of 15 - 36 months ( mean 24.5 ± 7.8 months ), all the infectious symptoms disappeared in all the patients. Infectious indicators such as ESR returned to normal at 3 months after the operation, and bone union was achieved at 4-8 months after the operation based on the X-ray iflms. The postoperative VAS pain scores were ( 2.92 ± 0.76 ) points, ( 1.33 ± 0.47 ) points and ( 0.33 ± 0.62 ) points respectively at 3 months and 6 months after the operation and at the ifnal follow-up, which were signiifcantly decreased when compared with the preoperative score of ( 6.58 ± 0.76 ) points (P < 0.05 ). The ASIA classification was signiifcantly improved when compared with the preoperative value, and the differences were statistically signiifcant (P < 0.05 ).Conclusions Radical debridement of intraspinal abscesses and granulomas and full never root and spinal canal decompression could be achieved by posterior approach. Pedicle screw internal ifxation facilitates instant lumbar stability and normal physiological curvature, and postoperative lumbar instability could be avoided. One-stage posterior lumbar surgery combined long-term chemotherapy are effective in the treatment of lumbar Brucella spondylitis.
Keywords：SpondylitisBrucellosisLumbar vertebraeAnti-bacterial agentsSurgical proceduresoperative
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 787-791 )