title: [Comparison of effectiveness between two surgical methods in treatment of thoracolumbar brucella spondylitis].
abstract: OBJECTIVE
  To compare the effectiveness between the method of simple posterior debridement combined with bone grafting and fusion and internal fixation and the method of one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in the treatment of thoracolumbar brucella spondylitis so as to provide the reference for the clinical treatment.
  
  
  METHODS
  A retrospective analysis was made on the clinical data of 148 cases of thoracolumbar brucella spondylitis between January 2002 and January 2012. Simple posterior debridement combined with bone grafting and fusion and internal fixation was used in 78 cases (group A), and one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in 70 cases (group B). There was no significant difference in gender, age, disease duration, involved vertebral segments, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, neural function grade of America Spinal Injury Association (ASIA), and kyphosis Cobb angle before operation between 2 groups (P > 0.05). The peri operation period indexes (hospitalization time, operation time, and intraoperative blood loss) and the clinical effectiveness indexes (VAS score, ASIA grade, Cobb angle, and ESR) were compared; the bone fusion and the internal fixation were observed.
  
  
  RESULTS
  Incision infection and paravertebral and/or psoas abscess occurred in 2 and 3 cases of group A respectively. All incisions healed by first intention and 2 cases had pneumothorax in group B. The operation time and the hospitalization time of group A were significantly shorter than those of group B (P < 0.05), and the intraoperative blood loss of group A was significantly lower than that of group B (P < 0.05). All of the cases in 2 groups were followed up 14- 38 months, 25 months on average. The VAS, ESR, and Cobb angle were significantly decreased at each time point after operation when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The neurological function was significantly improved at 3 months after operation; there were 1 case of ASIA grade C, 14 cases of grade D, and 63 cases of grade E in group A, and there were 1 case of grade C, 11 cases of grade D, and 58 cases of grade E in group B; and difference was not significant (Z = 0.168, P = 0.682). The grafting bone fusion was observed in both groups. The fusion time was (8.7 ± 0.3) months in group A and (8.6 ± 0.4) months in group B, showing no significant difference (t = 0.591, P = 0.601) was found. At last follow-up, no loosening or fracture of internal fixation was found.
  
  
  CONCLUSIONS
  Based on regular medicine therapy, the effectiveness of the two methods is satisfactory in the treatment of thoracolumbar brucella spondylitis as long as the operation indications should be controlled strictly.
authors.affiliation: Department of Orthopaedics,  First Affiliated Hospital of Hebei North University, Zhangjiakou Hebei, P.R. China. yxm1120@sohu.com
authors.forename: Xinming
authors.initials: X
authors.lastname: Yang
authors.forename: Xianhong
authors.initials: X
authors.lastname: Zuo
authors.forename: Yongli
authors.initials: Y
authors.lastname: Jia
authors.forename: Yuefei
authors.initials: Y
authors.lastname: Chang
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.forename: Yixing
authors.initials: Y
authors.lastname: Ren
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001174:Arthrodesis; D016025:Bone Transplantation; D002003:Brucella abortus / Q000302:isolation & purification*; D002006:Brucellosis / Q000175:diagnosis*; D003646:Debridement; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone; D006801:Humans; D007738:Kyphosis; D061646:Operative Time; D012189:Retrospective Studies; D013123:Spinal Fusion; D013131:Spine; D013166:Spondylitis / Q000382:microbiology* / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000382:microbiology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents