One-stage Surgical Management for Lumbar Brucella Spondylitis by Posterior Debridement, Autogenous Bone Graft and Instrumentation: A Case Series of 24 Patients.
METHODS
Clinical case series.


OBJECTIVE
The aim of this study was to explore the efficacy and safety of one-stage debridement, autogenous bone graft, and instrumentation for lumbar brucella spondylitis (LBS) via a posterior approach.


BACKGROUND
Reports on LBS are sporadic, and the therapeutic effect and safety of surgical interventions have not been assessed in clinical studies.


METHODS
Between January 2012 and January 2014, 24 consecutive patients with symptomatic LBS who underwent a one-stage operation that combined debridement, autogenous bone graft, and instrumentation via a posterior approach were enrolled. Back pain was measured using the visual analog scale (VAS). The neurological status was evaluated with the American Spinal Injury Association (ASIA) scale. Bone healing was evaluated based on postoperative plain x-ray or computed tomography.


RESULTS
All cases were followed up for an average of 14.3 + 3.5 months. The VAS scores were significantly improved at every follow-up interval. An improvement of at least one grade level was observed in the ASIA score of each patient. The average time of bone fusion was 6.8 + 1.6 months. Significant improvements of the average segmental Cobb angle was observed from a preoperative value of 18.4° + 4.6° to a last follow-up value of 21.1° ± 3.7°. At the last follow up, the titers of antibodies against the standard tube agglutination test, erythrocyte sedimentation rate, and C-reactive protein were negative for all patients.


CONCLUSIONS
For LBS, systemic antibrucellosis chemotherapy is the cornerstone of treatment. When cauda equine syndrome, radiculopathy, spinal instability, and severe back pain caused by extradural nonabsorbable abscess or progressive collapse are present, surgical intervention is inevitable. One-stage debridement, autogenous bone graft, and instrumentation via a posterior approach could represent an alternative treatment for LBS, and the efficacy and safety of these techniques are satisfactory.


METHODS
4.
4th Orthopaedics Department of Orthopaedics hospital, Ankang City Central Hospital, No. 85 Jinzhou south Road, District Hanbin, Ankang City, Shanxi Province, China.
Yangbin
Y
Chen
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an City, Shanxi Province, China.
Jun-Song
JS
Yang
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an City, Shanxi Province, China.
Tao
T
Li
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an City, Shanxi Province, China.
Peng
P
Liu
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an City, Shanxi Province, China.
Tuan-Jiang
TJ
Liu
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an City, Shanxi Province, China.
Li-Min
LM
He
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an City, Shanxi Province, China.
Li-Xiong
LX
Qian
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an City, Shanxi Province, China.
Ding-Jun
DJ
Hao
D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002002:Brucella; D002006:Brucellosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003646:Debridement / Q000379:methods*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013166:Spondylitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome