The Clinical Efficacy Of Simple Posterior Internal Fixation And Posterolateral Bone Grafting For Thoracolumbar Brucella Spondylitis

Objective To observe and evaluate the clinical efficacy of simple posterior internal fixation,posterolateral bone grafting surgery to treat thoracolumbar Brucella spondylitis.Methods From June 2014 to February 2018,the total of 47 cases(29 males and 18females)with thoracolumbar Brucella spondylitis who received posterior internal fixation and posterolateral bone grafting surgery in our hospital were recruited in the study.The average age was 51.8±10.1 years(range: 34-73).The affected segments were from T7-S1 and equal to 2 or below.The 47 patients underwent posterior fixation and fusion.All the patients accepted anti-Brucella drugs before and after operation.The operation time,interoperation blood loss,hospitalization days were observed.Evaluation of operative efficacy values including Erythrocyte Sedimentation Rate(ESR),Hypersensitive C-reactive Protein(hs-CRP),Serum Tube Agglutination Test(SAT),Visual Analogue Scale(VAS),Oswestry Disability Index(ODI),American Spinal Cord Injury Association(ASIA)and Cobb angle.The modified MacNab criteria was used to evaluate the clinical efficacy.The Bridwell classification and CT fusion criteria to assess bone fusion.Results All of the 47 cases of patients were clinically cured without brucellosis recurrence during the follow-up of 24-100(38.0±18.1)months after surgery,and there were no cases of internal fixation falling off,breaking and loosening,no recurrence cases.The postoperative medication duration was 3-14(7.5±3.1)months.The operation time was60-240(112.0±41.0)minutes.The interoperation blood loss was 20-500(203.0±114.0)milliliter.The hospitalization days was 7-47(20.7±10.0)days.All the patients showed no aggravation of nerve injury after surgery,and all the surgical incisions were healed at onemonth after surgery.At six months follow-up,the ASIA scale was improved to grade E.The VAS scores,ODI,ESR,hs-CRP and Cobb angles of the 47 cases of patients were all significantly decreased after surgery,and the difference of pre-operation and postoperation was statistically significant(P<0.05).Before operation,the average VAS scores was8.06±1.99,and the average ODI was 76.33±18.97.At one month and two years after surgery,the average VAS scores was 3.62±0.85 and 0.28±0.58.At three months and two years after surgery,the average ODI was 31.19±5.50 and 5.72±8.13.Before operation,the average ESR was 39.72±25.85 mm/h,and the average hs-CRP was 33.06±32.67 mg/L.The average ESR and the average hs-CRP returned to normal range was at 3 months and 6 months after surgery,respectively.At two years after surgery,the average ESR and the average hs-CRP was4.66±2.51 mm/h and 1.17±0.84 mg/L respectively.Before operation,the average Cobb angle was(20.91±12.55)°,At one day and two years after surgery,the average Cobb angle was(11.70±7.09)° and(13.54±9.64)°,respectively.At two years follow-up,the SAT titer of all patients was less than 1:100.According to the MacNab criteria,the satisfactory rate was95.74%(45/47).The bridwell bone fusion rate was 89.36%(42/47),and the CT fusion rate was93.62%(44/47).Conclusion Based on regular anti-Brucella therapy,the simple posterior internal fixation,posterolateral bone grafting surgery can obtain the good clinical curative effect.In addition,the method of posterior intervertebral fixation and posterolateral fusion have the advantage of less trauma,simpleness and speedy.