One-stage Surgical Management for Lumbar Brucella Spondylitis by Posterior Debridement, Autogenous Bone Graft and Instrumentation

Chen, Yangbin; Yang, Jun-Song; Li, Tao; Liu, Peng; Liu, Tuan-Jiang; He, Liang; Qian, Liying; Hao, Dingjun

doi:10.1097/brs.0000000000002093

Cited by 18 publications

(25 citation statements)

References 19 publications

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“… 126 In contrast, it has been reported that a single-stage procedure is a safe and efficient way to control infection and simultaneously reconstruct the spine. 127 , 128 Both techniques seem to be efficient; however, two-stage operations increase hospital stay and the already compromised patients may not be able to be withstand a second surgical procedure. The decision for the appropriate procedure should be based on surgical experience and general health status.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Spondylodiscitis revisited

et al. 2017

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Spondylodiscitis may involve the vertebral bodies, intervertebral discs, paravertebral structures and spinal canal, with potentially high morbidity and mortality rates.A rise in the susceptible population and improved diagnosis have increased the reported incidence of the disease in recent years.Blood cultures, appropriate imaging and biopsy are essential for diagnosis and treatment.Most patients are successfully treated by conservative means; however, some patients may require surgical treatment.Surgical indications include doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, and unresolved pain.Cite this article: EFORT Open Rev 2017;2:447–461. DOI: 10.1302/2058-5241.2.160062

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Section: Surgical Treatmentmentioning

confidence: 99%

Spondylodiscitis revisited

et al. 2017

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“…Also, only was one patient diagnosed with cervical changes in C6-C7. Similarly, other studies declared the lumbar vertebrae as the most commonly involved site in brucellosis spondylitis (40,41).…”

Section: Discussionmentioning

confidence: 79%

Brucellar Spondylitis in Kermanshah as an Endemic Area in West of Iran

Sayad

Mohamadi

Shirvani

et al. 2019

Arch Clin Infect Dis

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Background: Spondylitis is an important osteoarticular manifestation of brucellosis that leads to serious complications. Objectives: We aimed to investigate various aspects of spondylitis in brucellosis patients in Kermanshah, a highly endemic area in the West of Iran. Methods: This retrospective, single-center, cross-sectional study investigated 289 brucellosis patients among whom, 32 patients were confirmed to have brucellar spondylitis. The diagnosis of brucellosis was made by Wright or Coombs Wright tests (titers ≥ 1/80) or 2ME test (titer ≥ 1/40). Brucellar spondylitis was confirmed by vertebral MRI or whole-body bone scan. All analyses were done using SPSS 21 software. The chi-square or Fisher exact test was used for assessing associations. P values of < 0.05 were considered statistically significant.Results: Among 289 patients studied, 32 (11.07%) had spondylitis with a mean age of 53.44 ± 16.06 years. Unpasteurized dairy product consumption, rural residence, and livestock-related occupation were reported by 30 (93.7%), 22 (68.7%), and 28 (87.5%) patients, respectively. Back pain (100%) was the most common symptom while the temperature of ≥ 37.7 (50%) and vertebral column tenderness (50%) were the most observed signs. Brucellar spondylitis was statistically related to age > 40 years, admission duration > 10 days, and ESR > 40 mm/h but not to sex, fever, anemia, and Wright titer. The lumbar disc involvement was the most common involvement (90.6%) in brucellar spondylitis patients. Vertebral body involvement, abnormal marrow signal, and bone marrow edema were observed in all 31 patients diagnosed with MRI. Conclusions: Brucellar spondylitis should be considered in patients with lower back pain and fever in endemic areas. Positive Wright serology, vertebral body involvement in MRI, and elevated ESR greatly favor the diagnosis of this complication.

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“…The anterior approach has the advantage in lesion identi cation and differentiation from other adjacent tissues especially in the case of abscess. It enables the direct visualization of infected lesions and therefore can clear the lesion by using less time, especially in the removal of necrotic disc tissue and destroyed vertebrae to relieve the compression from the front of the spinal canal (17). The restoration of the anterior column through intervertebral bone grafting increased the spinal stability and repaired bone defects.…”

Section: Discussionmentioning

confidence: 99%

Investigation of The Optimal Surgical Approach to Brucella Lumbar Spondylitis Treatment: A Comparative Study

Jia¹,

Jian-guo²,

Li³

et al. 2020

Preprint

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Background: The optimal surgical approach in treating lumbar brucellosis (LBS) has not been determined. This study aims to compare the surgical efficacy of anterior approach and combined posterior and anterior approach in treating LBS.Method: A retrospectively cohort study included LBS patients undergoing lumber surgery in the Department of Orthopedics, Department of Orthopedics, Hebei Province from June 2012 to June 2016. According surgical approach, patients were divided into two groups; patients with one-stage anterior approach were classified into group A, and the rest of patients with combined posterior and anterior approach were group B. The operative time, intraoperative blood loss and, hospitalization stay were recorded to compare the surgical risk of two groups. In terms of treatment efficacy, visual analogue scale (VAS), bone graft fusion, erythrocyte sedimentation rate (ESR) and Oswestry disability index (ODI) were assessed and compared before and after surgery.Results: Eight-nine patients with LBS were included into the study. Fifty cases were males, and 39 patients were female. The mean age of this cohort was 61.9 ± 12 years, ranging from 23 to 78 years. Forty-nine patients were divided into group A, undergoing anterior debridement and bone graft fusion. Forty patients underwent posterior fixation combined with anterior approach (group B). The operation time of group A was 30 minutes shorter than that of group B. Group A had less intraoperative blood loss (800 vs. 900 ml; P <0.001). Hospital stay was four days shorter in group A. At the last follow-up, all patients were in good condition with ASIA Level E and ESR returned to normal. The bone fusion rate of Bridwell bone was 89.29% (45/49) and 80.00% (38/40) of group A and group B, respectively. In terms of surgical efficacy, there was no significant difference in VAS score between the two groups before and after operation (P > 0.05). Conclusions: One-stage anterior approach and combine posterior-anterior approach had no significant difference in terms of clinical efficacy. Individualized surgical treatment should be suggested in patients with complicated LBS and ineffective therapeutic treatment. Trial registration: This study has been retrospectively registered in local ethical Institution Review Board(No:[2020]068).

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One-stage Surgical Management for Lumbar Brucella Spondylitis by Posterior Debridement, Autogenous Bone Graft and Instrumentation

Abstract: 4.

Cited by 18 publications

References 19 publications

Spondylodiscitis revisited

Spondylodiscitis revisited

Brucellar Spondylitis in Kermanshah as an Endemic Area in West of Iran

Investigation of The Optimal Surgical Approach to Brucella Lumbar Spondylitis Treatment: A Comparative Study

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