Posterior Debridement Internal Fusion And Fixation For The Treatment Of Lumbar Brucella Spondylitis

Background: Brucellosis was defined as zoonotic category B infectious disease by national disease prevention and control institutions. Brucella could involve multiple organs of the body, musculoskeletal system was the most frequent involved. It affected the spine or vertebral disc called Brucella spondylitis. The main clinical manifestations were low back pain, high fever in the afternoon, sweating, vertebral and disc infection, spinal abscess and inflammation could also cause symptoms of spinal cord and nerve root damage. The combined application of antibiotics was used for the treatment of Brucella spondylitis. But clinical effect was not good when the patient was combined with the vertebral or spinal abscess, spinal instability and spinal cord or nerve root damage, surgical decompression was the principal forms of treatment. The target of surgery was abscess, inflammatory granulation tissue and pathological vertebral body, disc. Posterior debridement internal fusion and fixation was emerged in recent years, the goal was to quickly relieve symptoms, restore and maintain the stability of the spine, increasing the fusion and cure rate and reduce recurrence.Objective: To observe the clinical effect of one-stage posterior debridement internal fusion and fixation for treatment of the lumbar Brucella spondylitis.Methods: A retrospective study 38 cases of Brucella spondylitis admitted to our department from February 2010 to March 2015, male 27 cases, female 11 cases, age 36 to 67 years old, average 51 years old. Postoperative pathology and bacterial cultures were confirmed to be brucellosis. Patients was treated with one-stage posterior debridement internal fusion and fixation because the clinical effect of combined application of antibiotics was not good, to observe the clinical efficacy, the bone graft fusion and the patient's ODI score, VAS score with postoperative one weeks, three months, twelve months and the last follow-up. Results were statistically analyzed with SPSS 17.0.Results: All cases were followed up for 12 months to 24 months, an average of 16.8 months. Operations were successful, the mean operative time was 91.34±21.08 min, the average blood loss was 347.58±46.17 ml. No cerebrospinal fluid leakage and nerve damage. All patients were successfully completed surgery, no cerebrospinal fluid leakage and nerve injury. Primary healing of wounds were found in 31 patients, while 1 case got delayed wound healing. None of them had any infections. Results There were no recurrences in all patients. Results all cases had relieved within one week and could out-of-bed activity by themselves. On preoperative and postoperative one week, three months, one year for ODI and VAS score. The score of ODI results respectively was 36.51±8.58, 25.16±7.18, 9.37±2.23 and 7.91±1.78; VAS was 7.9±1.3, 4.2±0.9, 1.5±0.6 and 1.1±0.3. After each time point compared with preoperative improved significantly(p<0.05). The ODI score was improve significantly to 75.4±9.81%. There was no complication such as screw abruption, nonunion in all cases after twelve months later.Conclusion: One-stage posterior debridement internal fusion and fixation combined with the application of antibiotics for treatment of the lumbar Brucella spondylitis not only could quickly relieve symptoms, reduce bed rest of the patient, maintenance biomechanical stability of spine, but also could increase union and the cure rate and reduce recurrence, it was a safe and effective therapy method.