Comparison of two surgical interventions for lumbar brucella spondylitis in adults: a retrospective analysis

Abstract

This retrospective study aimed to compare the clinical efficacy of the posterior procedure with the combined anterior and posterior procedure in the surgical management of lumbar Brucella spondylitis. From January 2015 to June 2020, a total of 62 patients presenting with lumbar Brucella spondylitis underwent either one-stage posterior pedicle fixation, debridement, and interbody fusion (Group A, n = 33) or anterior debridement, bone grafting, and posterior instrumentation (Group B, n = 29). All patients were followed up for an average of 25.4 ± 1.5 months and achieved complete resolution of lumbar Brucella spondylitis. No significant differences between the groups were observed in terms of age or pre-operative, three-month postoperative and final follow-up indices of the VAS, ESR, CRP, lordosis angle, ODI scores, fusion time, and time of serum agglutination test conversion to negative (P > 0.05). Each patient exhibited notable improvements in neurological function, as assessed by the JOA score rating system. Group A demonstrated significantly shorter operative duration, intraoperative blood loss, and hospital stay compared to Group B (P < 0.05). Superficial wound infection was observed in one case in Group A, whereas Group B experienced one case each of intraoperative peritoneal rupture, postoperative ileus, iliac vein injury, and superficial wound infection. This study supports the efficacy of both surgical interventions in the treatment of lumbar Brucella spondylitis, with satisfactory outcomes. However, the posterior approach demonstrated advantages, including reduced surgical time, diminished blood loss, shorter hospital stays, and fewer perioperative complications. Consequently, the one-stage posterior pedicle fixation, debridement, and interbody fusion represent a superior treatment option.

Brucella Spondylitis: Current Knowledge and Recent Advances

“…However, the posterior approach demonstrates advantages such as reduced surgical time, less blood loss and hospital stays, and fewer perioperative complications. Therefore, the one-stage posterior pedicle fixation, debridement, and interbody fusion represent a superior treatment option [118]. Significant shorter operation time, hospitalization time, and intraoperative blood loss has also been reported in patients with thoracolumbar Brucella spondylitis who were treated with posterior debridement and instrumented fusion compared to patients treated with onestage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation (360 • surgery).…”