Surgical Treatment And Clinical Observation Of Intraspinal Granuloma Caused By Brucellosis Spondylitis

Objective : A retrospective analysis was made on the efficacy of the first-stage posterior total laminectomy and limited laminectomy,lesion removal,and internal fixation with bone grafting in the treatment of intraspinal granuloma caused by brucellosis spondylitis,to provide a reference for the selection of clinical treatment methods.Methods: A retrospective analysis of the first hospital affiliated to hebei institute of north from January 2010 to June 2018 were 48 cases in line with the surgical indications of bloom bacillus disease sex spondylitis cause spinal canal granuloma in patients with clinical data,all patients after the issue of posterior lesions cleared bone graft fusion and internal fixation treatment,according to the operation method is divided into two groups: group A(one stage posterior vertebral plate limited resection,lesion clearance and bone graft fusion and internal fixation): A total of 27 cases,18 were male,female 9 cases;The average age is(57.5±5.6)years old.The course of disease ranged from 8 to 27 months,with an average of(12.5±3.1)months.Group B(one-stage posterior total laminectomy,lesion removal,bone graft fusion and internal fixation): 21 cases,14 males and 7females.The average age is(52.6±4.5)years old.The course of disease ranged from 6 to 30 months,with an average of(14.3±4.5)months.Analysis and comparison of group A and group B operation time,intraoperative blood loss,hospital stay,postoperative c-reactive protein before and after surgery(C-reactive protein,CRP)and blood sedimentation(erythrocyte sedimentation Rate,the ESR),before and after surgery inpatients with clinical manifestations,visual analog pain score(VAS score),Oswestry disability index(ODI score),spine after lobe(Cobb Angle),bone graft fusion time and grade of Frankel,nerve damage,Postoperative follow-up examination of lumbar X-ray and MRI was conducted to evaluate whether the internal fixation was loose,nail breakage,recurrence and formation of infected sinus tract.Both groups had neurological dysfunction before surgery.Results: all patients were followed up for 12 months.48 patients were diagnosed with brucellosis spondylitis caused by granuloma after preoperative laboratory examination,imaging examination and exclusion of spinal tumor and spinal tuberculosis.There was no recurrence or formation of infected sinus tract in postoperative imaging review.All patients were operated by the same treatment group.VAS score and ODI score of group A 1 month after surgery were significantly lower than those of group B(P<0.05).The intraoperative blood loss in group A was significantly less than that in group B(P<0.05),and the operative time in group B was significantly longer than that in group A(P<0.05).There was no statistically significant difference between the two groups in postoperative hospital stay,c-reactive protein and blood sedimentation before and after surgery,clinical manifestations of patients before and after surgery,time of bone graft fusion,VAS score and ODI score at the last follow-up(P > 0.05).There was no statistically significant difference in Cobb Angle and Frankel injury grade between the two groups 1 year after surgery(P > 0.05).Comparison between the two groups before and after surgery: c-reactive protein,blood sedimentation,VAS score,ODI score and Cobb Angle were significantly improved in the last follow-up compared with those before surgery,with statistically significant differences(P<0.05).The symptoms of lower back pain in all patients were significantly better than those before the operation,and the ability to live independently was restored.Conclusion: for all the brookings bacillus disease sex spondylitis patients with granulomatous intra-spinal canal,theissue of all posterior vertebral plate or limited lamina excision,lesion clearance and bone graft fusion and internal fixation treatment,a significant curative effect can be obtained,and the issue of posterior vertebral plate limited resection,lesion clearance and bone graft fusion and internal fixation with one stage posterior vertebral plate all surgical time is short,small trauma,less intraoperative bleeding,postoperative pain relief in patients with quick,the advantages of faster recovery of function.