Brucellosis Spondylitis Research Articles

Bone features reinforce differential diagnosis between tuberculous spondylitis and brucellosis spondylitis.

Tuberculous spondylitis (TS) and brucellar spondylitis (BS) both cause major long-term morbidity and disability. Though Spondylodiscitis is sensitive to magnetic resonance images, some are difficult to differentiate. This study aims to identify specific bone changes on computed tomography (CT) images, further to differentiate TS from BS. We retrospectively analyzed and enrolled 70 patients with TS and 65 with BS at our hospital from December 2012 to January 2024. Information of bone destruction and formation, vertebral wall integrity, osteosclerosis, and sequestrum on CT images was collected and compared using the chi-square test or t-test. P < 0.01 was considered statistically significant. Bone destruction was greater in the TS group compared to the BS group (519.55 mm2 vs. 316.00 mm2, t = 6.01, P < 0.001), preferentially involving each third of the vertebral body horizontally (41.22% vs. 16.67%, χ2 = 77.76, P < 0.001; positive predictive value [PPV] = 80.6%) and the area under the endplate and equatorial portion of the vertebra longitudinally (80.53% vs. 28.20%, χ2 = 134.19, P < 0.001, PPV = 82.75%). Patients with BS more frequently exhibited fan-shaped osteosclerosis (12.82% vs. 1.15%, χ2 = 71.30, P < 0.001; PPV = 86.96%), longer bone formation surrounding the vertebra (18.06mm vs. 1.97mm, t = 14.28, P < 0.001), and longer anterior bone formation (3.86mm vs. 0.92mm, t = 6.51, P < 0.001). Anterior and closed bone formation was more common in the BS group than in the TS group (44.87% vs. 7.63%, χ2 = 152.53, P < 0.001; PPV = 77.78%). Fragmented and blocked sequestrum was more common in the TS group than in the BS group and tended to spread in and out of the erosions (22.14% vs. 0.64%, PPV = 98.31% and 22.14% vs. 0.00%, PPV = 100%, χ2 = 102.43, P < 0.001). TS and BS exhibit specific features of bone formation, bone destruction, and sequestrum on CT imaging. Our findings indicate that bone features on CT can help clinicians distinguish between two spinal infections.

MRI findings and classification of brucella spondylitis: a China multicenter study.

To propose a magnetic resonance imaging (MRI) classification of brucellosis spondylitis (BS) to determine a standard treatment method and a standard of post-treatment MRI follow-up. This is a multicenter retrospective cohort study. All patients diagnosed with BS at six hospitals for 12years, were included in the study. Data were collected retrospectively from the medical records of the patients. The classification of the cases was based on MRI. We analyzed MRI features of BS was categorized them into three types. Six hundred fifteen patients were included in the study, 78.9% of whom were males. The mean age was 53.05 ± 11.06years. Involvement of single vertebrae occurred in 6.2% of patients, while 72.7% involved two vertebrae and 21.1% involvement of more than two vertebrae. The most common of the lumbar spine was 64.6%. The main findings of MRI were affected vertebral endplate 2/3 above (60.7%), intervertebral space narrow (77.9%), intervertebral disc involvement (83.6%), paravertebral abscess (50.9%), disc abscess (49.6%), epidural abscess (43.3%), vertebra height change (22.1%), psoas abscess (22.0%), and abnormal vertebral accessory (10.2%). MR imaging of BS was categorized into three types. Type I: 57 (9.3%) patients; Type II: 526 (85.5%) patients, including IIa (26.5%), IIb (36.9%), and IIc (22.1%); Type IV: vertebral appendage type, 63 (10.2%) cases; Type III: 32 (5.2%) patients. MRI features of multicenter data can provide theoretical support for diagnosing BS. MRI classification of BS can afford better help for clinical treatment and follow-up after clinical treatment.

One-stage posterior debridement and spinal internal fixation for the treatment of lumbar Brucellar spondylitis

To explore the clinical efficacy and safety of one-stage posterior lesion removal and internal spinal fixation in patients with lumbar Brucellosis spondylitis. The clinical data of 24 patients admitted from October 2017 to October 2022 were retrospectively analyzed, 2 patients were lost to follow-up at 10 months after surgery, at the final 22 cases were included in the study, including 13 males and 9 females with an average age of (52.00±6.89) years old, were treated with one-stage posterior lesion removal and internal spinal fixation. The operation time, intraoperative bleeding, follow-up time, erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) before and after operation were recorded. The pain visual analogue scale(VAS), Oswestry disability index(ODI), the Japanese Orthopaedic Association(JOA) score for neurofunction, American Spinal Injury Association(ASIA) spinal cord injury grade and modified MacNab criteria were ussed to evaluate the efficacy. All patients were followed up from 12 to 30 months with an average of (17.41±4.45) months. The operation time was 70 to 155 min with an average of (116.59±24.32) min;the intraoperative bleeding volume was 120 to 520 ml with an average of (275.00±97.53) ml. CRP and ESR levels decreased more significantly at 1 week and at the final follow-up than preoperative levels(P<0.05). VAS, JOA score and ODI at 1 week and at the latest follow-up were more significantly improved than preoperative results(P<0.05). There was no significant difference between ASIA preoperative and 1 week after operation(P>0.05), and a significant difference between preoperative and last follow-up(P<0.05). In the final follow-up, 21 patients had excellent efficacy, 1 patient had fair, and there was no recurrence during the follow-up. One-stage transpedicular lesion removal and internal spinal fixation, with few incisions and short operation time, helps the recovery of neurological function, and the prognosis meets the clinical requirements, which can effectively control Brucella spondylitis.

(245) Epididymo-Orchitis as the First Presentation of Brucellosis in an Endemic Area

Abstract Introduction Brucellosis, which is also called Mediterranean or Malta fever, is an endemic enzootic disease and can involve various organ systems. It is commonly endemic in the Mediterranean countries and the Middle East. Epididymo-orchitis is a focal form of human brucellosis. Brucella species cause granulomatous orchitis usually presenting as an acute or chronic unilateral swelling of the testis. Patients rarely present to the clinicians with acute scrotum due to Brucellosis Epididymo-Orchitis (BEO) as an initial finding. Objective Our aim is to estimate the prevalence of the BEO among the cases diagnosed with Epididymoorchitis in our hospital over the last four years. Methods Retrospective study from 2015–2018 involving all cases diagnosed with Epididymoorchitis in our hospital. A total of 92 cases of Epididymoorchitis were diagnosed during this period. These cases presented to ER complaining of severe unilateral scrotal pain, swelling, fever and sweating. Local examination showed swollen enlarged testis and epididymis with marked tenderness. Brucella serologic test for both B abortus and B melitensis were requested routinely for all cases of epididymo-orchitis. Scrotal Doppler ultrasonographic examination was requested at initial diagnosis and after 2 weeks to exclude abscess formation. Results Out of 92 cases, 8 were diagnosed to have brucellosis (8.7%). The median age of patients was 32 years (range, 18–41 years). All patients had positive history of consuming unpasteurized dairy products, which is a risk factor for brucellosis. The diagnosis of brucellosis was made via positive serological testing results (Brucella abortus and melitensis). One case showed testicular abscess formation. All cases were given combination of tetracyclin and rifampicin for 6–12 weeks. Two cases required prolonged hospital stay due to testicular abscess formation in one and development of Brucellosis spondylitis in the other. Gentamycin was added for one week in such cases. Conclusions In endemic regions for brucellosis, we have to consider it in the workup of all cases of epididiymo-orchitis. The diagnosis is easy by positive serology tests. Positive cases need special antibiotic combination protocol for longer time and close monitoring for development of local complications or other systemic brucellosis manifestations Disclosure No.

Progress in Diagnosis and Treatment of Bru-cellosis Spondylitis with Traditional Chinese and Western Medicine

Progress in Diagnosis and Treatment of Bru-cellosis Spondylitis with Traditional Chinese and Western Medicine

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

The purpose of this study is to verify whether early stage patients with single-segment lumbar Brucella spondylitis can still be cured through simple posterior fixation and bone grafting, even without debridement. A retrospective study was conducted on 63 patients diagnosed with single-segment lumbar brucellosis spondylitis, who underwent posterior-only debridement (or not), bone grafting, and instrumentation from June 2016 to June 2019. Group A comprised 34 patients who did not undergo debridement, while group B comprised 29 patients who underwent debridement. The clinical data and imaging results of the patients were compared between the 2 groups to evaluate the clinical effects of debridement or not. Both groups of patients completed at least 1 year of follow-up. The group A had significantly lower values for operation time, blood loss, and hospital stay compared to the group B (P < .05). There were no significant differences between the 2 groups in terms of erythrocyte sedimentation rate, C-reactive protein, visual analogue scores, improvement of Japanese Orthopaedic Association Evaluation of treatment score, and Cobb angle. The bone fusion rate was 92% (31 patients) in group A and 96% (28 patients) in group B, with no significant difference between the 2 groups (P > .05). In summary, these findings suggest that posterior fixation and bone graft fusion are effective treatments for single-segment lumbar brucellosis spondylitis in early stages even without debridement. Importantly, these procedures offer several benefits, such as minimal trauma, short operation times, rapid postoperative recovery, and favorable bone graft fusion outcomes.

Comparative Study on the Efficacy of Two Perioperative Chemotherapy Regimens for Lumbar Brucellosis.

The clinical efficacy of perioperative chemotherapy regimen (rifampicin, doxycycline, levofloxacin, ceftriaxone) was evaluated for lumbar brucellosis spondylitis patients with neurological injury. In Beijing Ditan Hospital affiliated with Capital Medical University, 32 patients with lumbar brucellosis spondylitis underwent surgery and triple perioperative chemotherapy (rifampicin, doxycycline, levofloxacin) between 2011 and 2021 due to neurological injury, and 34 patients matched up with the triple group underwent rifampicin, doxycycline, levofloxacin, and ceftriaxone. Both groups were compared in terms of changes in inflammation index, low back/leg pain, lumbar function, neurological function, and adverse drug reactions. There was no significant difference in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), low back pain visualanalogue scale (VAS), leg pain VAS, lumbar Oswestry disability index (ODI) and nerve function injury rate between the two groups before chemotherapy (P>0.05). The ESR, CRP at 1 week and 2 weeks after chemotherapy and 1 week, 2 weeks, 1 month postoperatively in the quadruple group were significantly lower than those in the triple group, which is the same to ESR 3 months postoperatively (P<0.05). The low back pain VAS, leg pain VAS and lumbar ODI in the quadruple group were significantly lower than those in the triple group at 1 month and 3 months postoperatively (P<0.05). The recovery rate of neurological function in the quadruple group was significantly higher than that in the triple group at 3 and 6 months postoperatively (P<0.05). Both groups did not experience significantly different perioperative and postoperative adverse reactions (P>0.05). For lumbar brucellosis spondylitis with neurological injury, quadruple perioperative chemotherapy of rifampicin, doxycycline, levofloxacin and ceftriaxone can significantly reduce perioperative inflammation, and improve low back/leg pain, as well as promoting neurological function recovery in the short term.

Clinical value and effectiveness profiles of oblique lateral interbody fusion and posterior lumbar interbody fusion in the treatment of lumbar brucellosis spondylitis.

The aim of this study was to assess the clinical efficacy of oblique lateral interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) for lumbar brucellosis spondylitis. Between April 2018 and December 2021, 80 cases of lumbar brucellosis spondylitis admitted to our institution were evaluated for eligibility and randomly assigned to either PLIF (group A, lesion removal by posterior approach + interbody fusion + percutaneous pedicle screw internal fixation) or OLIF (group B, lesion removal by anterior approach + interbody fusion + percutaneous pedicle screw internal fixation). The outcome measures included operative time, intraoperative bleeding, hospital stay, preoperative and postoperative visual analogue scale (VAS) ratings, American Spinal Injury Association (ASIA) classification, Cobb angle, and interbody fusion time. PLIF resulted in shorter operative time and hospital stay and less intraoperative bleeding vs. OLIF (p<0.05). All eligible patients showed significantly lower VAS scores, and smaller ESR values and Cobb angles after treatment (p<0.05), but no significant intergroup differences were observed (p>0.05). The two groups showed similar preoperative ASIA (American Spinal Injury Association) classification and interbody fusion time (p>0.05). PLIF was associated with better ASIA classification at three months postoperatively vs. OLIF (p<0.05). Both surgical techniques are efficient at removing the lesion, relieving pain, maintaining spinal stability, promoting implant fusion, and facilitating prognostic inflammation control. PLIF features a shorter surgical duration and hospital stay, less intraoperative bleeding, and greater neurological improvement vs. OLIF. Nevertheless, OLIF outperforms PLIF in the excision of peri-vertebral abscesses. PLIF is indicated for posterior spinal column lesions, particularly those with spinal nerve compression in the spinal canal, whereas OLIF is indicated for structural bone deterioration in the anterior column, particularly for those with perivascular abscesses.

Establishment of Standardized Diagnostic System for Brucella Spondylitis in the Elderly and Clinical Application of Precise Treatment Strategy

Objectives Establish a clinical standardized diagnosis and treatment strategy system for senile brucellosis spondylitis, and evaluate the clinical effect of applying this diagnosis and treatment system in order to improve the diagnosis rate and cure rate of the disease. Methods A diagnostic system was established based on the medical history, clinical, imaging, laboratory, bacteriological and pathological examinations of 70 elderly patients with brucellosis spondylitis admitted from January 2002 to December 2017. All patients received standardized drug therapy, anti-osteoporosis therapy and adjuvant hyperbaric oxygen therapy. Forty-two patients with spinal nerve injury received surgical treatment. Follow-up and evaluation were conducted at 2 weeks, 1 month, 3 months, 6 months, and 12 months after treatment. Results All patients were diagnosed after admission according to the diagnostic system standard examination. In this group, 28 patients (40%) received standardized drug therapy for non-surgical indications (group A), and 42 patients (60%) received surgical treatment for surgical indications (group B). VAS scores were significantly different between the two groups (P<0.05), group B was better than group a. Imaging scores showed that in group B, the myelopathy segments were stable without abscess and inflammatory granuloma, except for slow bone repair in the debridement area of the original myelopathy. Group A had no obvious vertebral lesion infiltration and interstitial infection absorption after 3 months of treatment, and gradually absorbed vertebral inflammatory infiltration and interstitial infection after 6 months. Clinical efficacy evaluation showed that both groups achieved good cure rates over time, and group B was better than group A (P<0.05). Conclusion Elderly brucellosis spondylitis has characteristic manifestations, and the establishment of a standardized diagnosis system will help improve the diagnosis rate; Synchronous drug therapy for BS and osteoporosis according to the treatment strategy has a good effect, and for patients who meet the indications for surgery, timely surgery can relieve or relieve pain, maintain spinal stability, and promote rapid recovery of nerve and spinal functions. It has obvious advantages and can better improve the clinical cure rate.

Imaging study to establish the classification criteria of brucellar spondylitis based on MRI findings

Objective: Establishment of brucellosis spondylitis of imaging classification; provision reference for clinical treatment methods. Methods: Form January 2008 to July 2012, 89 cases imaging data confirmed by clinical examination and laboratory of brucellosis spondylitis patients were analyzed retrospectively, based on X-ray, CT and MRI imaging of their clinical manifestations- Vertebral inflammatory infiltration and extent of the damage, the extent of damage to the intervertebral space, periostitis inflammatory changes, paraspinal abscess, spinal cord, cauda equina and nerve root compression. All this imaging indicators above were the evaluation criteria. Acquisition and analysis of the imaging data was implemented by the blinded reading group which was composed of Imaging Center physicians and orthopedic surgeons. According to these imaging performances, develop the imaging classification. Results: Brucellosis spondylitis image was made up of I-VI type: type I: vertebral inflammation; type II: Discitis; type III: periostitis; type IV: abscess; type V: spinal nerve and type VI: compound. The group of 54 cases accounted for 60.67% of the compound, in which the incidence of type I Image companied by type II was maximum: 22 cases accounted for 40.74% (22/54) and second type II Image and companied by V type was 20 cases: accounted for 37.03% (20/54). In the group, 35 cases of simple type accounted for 39.33%: type I: 4 cases; type II: 12 cases; type III: 3 cases; type IV: 2 cases; type: 4 cases. Simple and complex type of type II imaging accounted for 59.55% (53/89) the highest occurrence rate, in which the type I was 47 cases: accounted for 52.81% (47/89). Based on imaging classification, 67 cases was treated by surgery, in which 59 cases was treated by debridement and 8 cases was treated by percutaneous minimally invasive surgery, 22 cases was not treated by surgery. The group of 89 cases had been followed for 1 year: 83 cases had been cured without prognosis, and 6 cases had been improved. Conclusion: Brucellosis spondylitis images classification has a reference value and guiding significance for the strategies of clinical treatment. According to this classification, simply type I, type II, type III, and IV type can be used in clinical conservative treatment, and when the evolution of the disease has surgical indications, or type V and VI type the patients should be treated actively by surgery

A plasma 3-marker microRNA biosignature distinguishes spinal tuberculosis from other spinal destructive diseases and pulmonary tuberculosis.

Accurate spinal tuberculosis (TB) diagnosis is of utmost importance for adequately treating and managing the disease. Given the need for additional diagnostic tools, this study aimed to investigate the utility of host serum miRNA biomarkers for diagnosing and distinguishing spinal tuberculosis (STB) from pulmonary tuberculosis (PTB) and other spinal diseases of different origins (SDD). For a case-controlled investigation, a total of 423 subjects were voluntarily recruited, with 157 cases of STB, 83 cases of SDD, 30 cases of active PTB, and 153 cases of healthy controls (CONT) in 4 clinical centers. To discover the STB-specific miRNA biosignature, a high-throughput miRNA profiling study was performed in the pilot study with 12 cases of STB and 8 cases of CONT using the Exiqon miRNA PCR array platform. A bioinformatics study identified that the 3-plasma miRNA combination (hsa-miR-506-3p, hsa-miR-543, hsa-miR-195-5p) might serve as a candidate biomarker for STB. The subsequent training study developed the diagnostic model using multivariate logistic regression in training data sets, including CONT(n=100) and STB (n=100). Youden's J index determined the optimal classification threshold. Receiver Operating Characteristic (ROC) curve analysis showed that 3-plasma miRNA biomarker signatures have an area under the curve (AUC) = 0.87, sensitivity = 80.5%, and specificity = 80.0%. To explore the possible potential to distinguish spinal TB from PDB and other SDD, the diagnostic model with the same classification threshold was applied to the analysis of the independent validation data set, including CONT(n=45), STB(n=45), brucellosis spondylitis (BS, n=30), PTB (n=30), spinal tumor (ST, n=30) and pyogenic spondylitis (PS, n=23). The results showed diagnostic model based on three miRNA signatures could discriminate the STB from other SDD groups with sensitivity=80%, specificity=96%, Positive Predictive Value (PPV)=84%, Negative Predictive Value (NPV)=94%, the total accuracy rate of 92%. These results indicate that this 3-plasma miRNA biomarker signature could effectively discriminate the STB from other spinal destructive diseases and pulmonary tuberculosis. The present study shows that the diagnostic model based on 3-plasma miRNA biomarker signature (hsa-miR-506-3p, hsa-miR-543, hsa-miR-195-5p) may be used for medical guidance to discriminate the STB from other spinal destructive disease and pulmonary tuberculosis.

Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis.

This study aims to investigate the effectiveness and feasibility of biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis (LBS). The data of 13 patients with LBS were retrospectively analyzed, who underwent biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation from May 2020 to June 2022. The patients' clinical data, the duration of operation, the estimated blood loss (including postoperative drainage), and complications were recorded. Clinical outcomes include serum agglutination test (SAT) measures Brucella antibody titer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analog scale (VAS) scores of low back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), American Spinal Injury Association neurological classification, and lordotic angle were analyzed. All patients were assessed using the modified Macnab criteria at the final follow-up. The intervertebral bone graft fusion was assessed using the Bridwell grading criteria. The mean operation duration was 177.31 ± 19.54 min, and the estimated blood loss was 176.15 ± 43.79 ml (including postoperative drainage was 41.15 ± 10.44 ml). The mean follow-up period was 13.92 ± 1.5 months. SAT showed that the antibody titers of 13 patients were normal 3 months after the operation and at the final follow-up. ESR and CRP levels returned to normal by the end of the 3-month follow-up. VAS scores of low back and leg, JOA score, and ODI significantly improved after the operation throughout the follow-up period (P < 0.05). Based on the modified Macnab criteria, 92.3% showed excellent to good outcomes. One patient had only a percutaneous screw internal fixation on the decompression side due to severe osteoporosis. One case suffered a superficial incision infection postoperatively that healed with dressing change and effective antibiotic treatment. Bony fusion was obtained in all patients at the last follow-up, including 12 cases with grade I and 1 case with grade II, with a fusion rate of 92.31%. Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation is an effective, safe, and viable surgical procedure for the treatment of LBS.

Establishment and Clinical Application of Multidisciplinary Collaborative Rapid Rehabilitation Nursing Pathway in Perioperative Period of Brucellosis Spondylitis

Establishment and Clinical Application of Multidisciplinary Collaborative Rapid Rehabilitation Nursing Pathway in Perioperative Period of Brucellosis Spondylitis

Establishment and Clinical Application of One-stage Posterior Limited Lesion Clearanceand Internal Fixation Combined With Personalized Drug Therapy System for Brucellosis Spondylitis

Establishment and Clinical Application of One-stage Posterior Limited Lesion Clearanceand Internal Fixation Combined With Personalized Drug Therapy System for Brucellosis Spondylitis

Epidemiological Investigation of Brucellosis Spondylitis and Optimal Selection of Clinical Drug Compatibility, Treatment Course and Treatment Plan

Background: Brucellosis is a zoonotic endemic disease, the main source of infection is infected cattle, sheep, pigs and their products. In recent years, the global incidence of brucellosis spondylitis has increased year by year, and it has spread from pastoral areas to semi-agricultural and semi-pastoral areas, agricultural areas and cities. It has changed from a mainly occupational disease to a mainly food-borne disease, and it is also a zoonotic specific spinal infectious disease that WHO and governments around the world pay great attention to. Due to the low cure rate and high recurrence rate of traditional drug therapy regimen. Therefore, to carry out epidemiological investigation and Related research on clinical drug therapy of brucellosis spondylitis has practical significance for improving diagnosis rate, cure rate and reducing recurrence rate. Objective: To analyze the epidemiological characteristics of Brucellosis spondylitis and explore the choice of drugs and the best drug treatment plan, so as to provide scientific basis for improving the prevention and control of the disease and treatment effect. Methods: Clinical epidemiodogical materials were collected from 113 patients with brucellar spondylitis. All these patients were divided into 5 different groups according to 5 kinds of drugs adopted respectively, and then the patients were given different course of treatment. Results: In the 113 patients, brucellar spondylitis morbility of female patients were higher than that of male ones, and the morbility of Bashang were higher than that of Baxia. These patients were infected mainly through browsing and breeding beasts. Lumbars were the major focus of infection. It was very comnlon that two adjacent lumbars were involved in concurrently. L4 was the most common infection location and its demolishment was most serious. The curative effect of group treated with doxycycline was better than that of group treated without doxycycline. If the course of treatment Was increased, the curative effect Was not increased obviously. Conclusions: There are characteristic features in clinical epidemiology of brucell spondylitis. Doxycycline + Rifampicin + Sulfamethoxazole was used as the preferred antibiotic. Using antibiotics adequately and jointly by two courses of treatment for a long time is the most reasonable way to treat the disease and prevent the disease from recurrence.

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

BackgroundThis 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).MethodsFrom 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.ResultsA 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.ConclusionOne-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.

Beneficial influence of single-stage posterior surgery for the treatment of lumbar brucella spondylitis combined with spondylolisthesis

We aimed to evaluate the clinical efficacy of the single-stage posterior surgical treatment for patients of lumbar brucella spondylitis combined with spondylolisthesis. In this study, we performed a retrospective analysis of 16 patients with lumbar brucellosis spondylitis combined with spondylolisthesis from January 2015 to January 2019. All patients underwent single-stage posterior lumbar debridement, reduction, interbody fusion, and instrumentation. Preoperative and postoperative of the visual analog scale (VAS), the Oswestry disability index (ODI), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were compared. In addition, the spondylolisthesis reduction rate, reduction loss rate, interbody fusion rate, and complication rate were recorded. VAS, ODI, ESR, and CRP were conducted with repeated analysis of variance data at different follow-ups. The postoperative follow-up was 12–36 months, with an average of (25.0 ± 8.1) months. VAS, ODI, ESR, and CRP were significantly better at 2-week and 1-year follow-up than preoperative results (P = 0.000, respectively). In addition, 1 year after the operation, VAS, ODI, ESR, and CRP showed a significant improvement (P = 0.000, respectively). The average spondylolisthesis reduction in 2 weeks after operation was (91.2 ± 6.7)%, and the median reduction loss rate in 1 year after operation was 8.0 (5.0, 9.8)%. At the last follow-up, all patients achieved interbody fusion, no loosening and fracture of instrumentation were found, and no recurrence happened. Single-stage posterior operation for lumbar debridement, reduction, interbody fusion, and instrumentation is beneficial for treating lumbar brucellosis spondylitis combined with spondylolisthesis. Furthermore, the reconstruction of spinal stability may relieve pain, heal lesions, and improve patients’ living.

Clinical Effect of Doxycycline Combined with Compound Sulfamethoxazole and Rifampicin in the Treatment of Brucellosis Spondylitis

ObjectiveThe purpose of this study was to determine the clinical value of triple antibiotic therapy consisting of doxycycline, compound sulfamethoxazole and rifampicin in the treatment of brucellosis spondylitis.MethodsA retrospective analysis was performed on 100 patients with brucellosis spondylitis admitted to the First Affiliated Hospital of Hebei North University from March 2016 to June 2019. Patients were divided into the following two groups: the control group (n = 50) treated with dual antibiotic therapy (rifampicin + compound sulfamethoxazole), and the observation group (n = 50) treated with triple antibiotic therapy (rifampicin + doxycycline + compound sulfamethoxazole). The treatment effect, low back pain relief, levels of erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and C-reactive protein (CRP), as well as the adverse reactions were compared between the two groups.ResultsThe response rate of the observation group was significantly higher than that of the control group (P < 0.05). Before treatment, there was no significant difference in the low back pain assessed by the visual analogue scale (VAS), or levels of ESR, PCT and CRP between the two groups (P > 0.05). But after treatment, the VAS score and the levels of ESR, PCT and CRP in observation group were lower than those in the control group (P < 0.05). No significant difference was found in the incidence of adverse reactions (P > 0.05).ConclusionThe triple antibiotic therapy of doxycycline, compound sulfamethoxazole and rifampicin is effective in the treatment of brucellosis spondylitis. It can significantly alleviate patients’ back pain and inflammation with a high safety profile, which is worthy of clinical application.

Evaluation of Conventional, Gadolinium-Enhanced, and Diffusion-Weighted MRI for Revealing Brucellosis Spondylitis of the Lumbar Spine

Background: Brucellosis is a highly contagious zoonosis caused by exposure to contaminated unpasteurized milk or undercooked meat, or contact with the secretions of infected animals. Although laboratory tests are the gold standard for diagnosis of brucellosis, the positive rate remains low (&lt;50%). A complication of brucellosis is lumbar brucellosis spondylitis (LBS). LBS is conventionally diagnosed using X-ray and computed tomography, however, they have low sensitivity in imaging the spine. Previous studies demonstrated that T1-weighted, T2-weighted, and gadolinium (GD)-based MRI can detect LBS. Note that diffusion-weighted MRI (DWI) is able to probe tissue microstructures quantitatively. However, the viability of DWI to diagnose LBS is unknown. Purpose: In this study, we investigated the feasibility of using DWI for diagnosing LBS, and also evaluated T1-weighted, T2-weighted, and Gd-MRI images. Materials and Methods: 79 patients (22–75 y) with brucellosis, which was confirmed by brucellosis serum agglutination test, underwent DWI as well as T1-weighted, T2-weighted, and Gd-MRI. Results: Among the 79 patients, 72.2% (57/79) showed various degrees of LBS. Relative to those without LBS, patients with LBS differed significantly with regard to maximum and minimum ADC values; maximum and minimum signal intensities of b-values= 500; and minimum signal intensities of b-value =800. The conventional MRI and Gd-MRI results were consistent with previous studies. Conclusion: Conventional MRI and Gd-MRI are able to detect LBS-induced changes, and DWI can quantitatively identify LBS. The combined use of conventional MRI, Gd-MRI, and quantitative DWI has great value for diagnosing LBS.

The use of magnetic resonance imaging using compression sensor measurement in the diagnosis of spondylitis due to brucellosis and the study of distinguishing spinal tuberculosis

Abstract Under the guidance of the theory of pressure sensor measurement, magnetic resonance imaging (MRI) was used to improve the efficiency of the examination. The clinical MRI data of 30 patients with Brucella spondylitis and 30 patients with spinal tuberculosis in the Infectious Disease Hospital are analyzed retrospectively. The similarities and differences of clinical manifestations between the two diseases Brucella spondylitis and spinal tuberculosis are obtained. From the comparison of the distribution of lesions, the number and number of cases of lumbar spine injury in two groups are far more than that of other lesions. Abnormal low signal of T1w1 and high signal of T2w1 can be found in pathological paravertebral soft tissue of patients with Brucella spondylitis. In addition, the spine infected by Brucella is usually located in the lumbar spine, with less damage and less edge damage. However, the destruction of vertebral body is very serious, kyphosis and multisegmental paravertebral abscess are obvious, and the risk of tuberculosis infection will also affect adjacent organs. According to the difference of imaging results, the typical spinal tuberculosis and brucellosis spondylitis can be distinguished, which was of great value and significance for diagnosis and differentiation.