Abstract
BackgroundSpinal brucellosis is a less commonly reported infectious spinal pathology. There are few reports regarding the surgical treatment of spinal brucellosis in existing literature. This retrospective study was conducted to determine the effectiveness of single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral spinal brucellosis.MethodsFrom February 2012 to April 2015, 32 consecutive patients (19 males and 13 females, mean age 53.7 ± 8.7) with lumbosacral brucellosis treated by transforaminal decompression, debridement, interbody fusion, and posterior instrumentation were enrolled. Medical records, imaging studies, laboratory data were collected and summarized. Surgical outcomes were evaluated based on visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scale. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms and complications were investigated. Graft fusion was evaluated using Bridwell grading criteria.ResultsThe mean follow-up period was 24.9 ± 8.2 months. Back pain and radiating leg pain was relieved significantly in all patients after operation. No implant failures were observed in any patients. Wound infection was observed in two patients and sinus formation was observed in one patient. Solid bony fusion was achieved in 30 patients and the fusion rate was 93.8%. The levels of ESR and CRP were returned to normal by the end of three months’ follow-up. VAS and ODI scores were significantly improved (P < 0.05). According to JOA score, surgical improvement was excellent in 22 cases (68.8%), good in 9 cases (28.1%), moderate in 1 case (3.1%) at the last follow-up.ConclusionsSingle-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation is an effective and safe approach for lumbosacral brucellosis.
Highlights
Spinal brucellosis is a less commonly reported infectious spinal pathology
General information A total number of 32 consecutive patients (19 males and 13 females, age: 53.7 ± 8.7, range 37-69 years) with lumbosacral brucellosis treated by single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation from February 2012 to April 2015 in our institution were included in this study (Table 1)
Initial diagnosis of spinal brucellosis was based on the presence of findings consistent with infection in lumbosacral region on plain radiography, Computed tomography (CT) and Magnetic resonance imaging (MRI) (Table 2) and the confirmed diagnosis was made by isolation of Brucella species from blood and/or standard tube agglutination test and revealing a titer of antibodies to Brucella of ≥1/160
Summary
There are few reports regarding the surgical treatment of spinal brucellosis in existing literature. This retrospective study was conducted to determine the effectiveness of single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral spinal brucellosis. Human brucellosis remains the most common zoonotic disease worldwide, with more than half a million new cases annually [1]. It is a systemic infection caused by facultative intracellular bacteria of the genus Brucella that can involve many organ systems. Treatment failure, sequelae are reported constantly [9]
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