One-stage posterior surgery combined with anti-Brucella therapy in the management of lumbosacral brucellosis spondylitis: a retrospective study

Abstract

Background This study aimed to assess the clinical efficacy of one-stage posterior surgery combined with anti-Brucella therapy in the treatment of lumbosacral brucellosis spondylitis (LBS). Methods From June 2010 to June 2020, the clinical and radiographic data of patients with LBS treated by one-stage posterior surgery combined with anti-Brucella therapy were retrospectively analyzed. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) and Oswestry Disability Index scores (ODI) were used to evaluate the clinical outcomes. Frankel’s classification system was employed to access the initial and final neurologic function. Fusion of the bone grafting was classified by Bridwell’s grading system. Results A total of 55 patients were included in this study with a mean postoperative follow-up time of 2.6 ± 0.8 years (range, 2 to 5). There were 40 males and 15 females with a mean age of 39.8 ± 14.7 years (range, 27 to 57). The Brucella agglutination test was ≥ 1:160 in all patients, but the blood culture was positive in 43 patients (78.1%). A statistical difference was observed in ESR, CRP, VAS, ODI, and JOA between preoperative and final follow-up (P < 0.05). Neurological function was significantly improved in 20 patients with preoperative neurological dysfunction after surgery. According to Bridwell’s grading system, the fusion of bone grafting in 48 cases (87.2%) was defined as grade I, and grade II in 7 cases (12.7%). None of the infestation recurrences was observed. Conclusion One-stage posterior surgery combined with anti-Brucella therapy was a practical method in the treatment of LBS with severe neurological compression and spinal sagittal imbalance.

Effect of closed suction irrigation on patients with brucellosis spondylitis after one-stage posterior debridement and bone grafting fusion with internal fixation: a randomized controlled trial

“…The lesions might slowly invade the articular surface of the vertebrae body and resulted in the proliferation and hardening of the articular surface when the anti-Brucella therapy was not intervened timely. The biomechanical structure stability of the intervertebral joint and spine sagittal balance might be destroyed if the progression continued [10]. In this study, the VAS of all patients decreased signi cantly after operation (average: 5.83 ± 1.05).…”

“…The spine is one of the most common sites of brucellosis infection, which is called brucella spondylitis (BS) [9]. Lumbosacral is the common region of the spinal brucella spondylitis, with an incidence of 2%-53%, especially L4-L5 level, and L5-S1 level [8,10], mainly manifested as spondylitis, discitis, myelitis or epidural abscess [11]. When conservative treatment fails, spinal abscess, spinal collapse, bone destruction, spinal cord compression, radiculopathy or spinal instability, surgical treatment is necessary [3,12].…”

Efficacy of posterior fixation and bone graft fusion for treatment of lumbar brucellosis spondylitis

“…[ 19 ] Furthermore, prolonged posterior landing times can worsen the occurrence of postoperative complications, such as pneumonia caused by falls and venous thrombosis in the lower extremities. [ 20 ] The findings of a previous systematic review by Joaquim [ 21 ] demonstrated that posterior laminectomy is an effective method for fixing the posterior column of the vertebral body, although it destroys the ligament complex between the support and the spinous process. While posterior internal fixation and intervertebral fusion can increase the stability of the diseased vertebrae, they also reduce mobility between vertebral bodies, which can exacerbate the incidence of adjacent spondylopathy.…”

Selection of treatment strategies for lumbar Brucella spondylitis: a retrospective clinical study

“…(1) Standard tube agglutination test (SAT) titer ≥1:160, positive rose bengal plate test (RBT), (2) intractable low back pain with or without nerve or spinal cord compression, (3) abscess formation in the paravertebral area, lumbaris major muscle or spinal canal, (4) Bone destruction characterized by small cavities, limited amount of necrotic bone, or large necrotic bone and cavities, (5) Complete availability of all case data and follow-up information.…”

“…If there are symptoms such as spinal instability, kyphosis deformity, neurological compression, or uncontrollable pain caused by the lesions, drug treatment may not significantly alleviate the symptoms. In such cases, surgical treatment can significantly improve symptoms, effectively control the progression of the disease, increase the cure rate, and reduce relapse ( 5 , 6 ). Therefore, this study analyzed clinical data of pure drug treatment, drug treatment-based posterior-only vertebral fusion, and posterior or anterior lesion clearance fusion in the treatment of lumbar brucella spondylitis.…”