Treatment of lumbar brucella spondylitis with negative pressure wound therapy via extreme lateral approach: A case report

Abstract

Brucella spondylitis (BS) is a specific spinal infection. Surgical treatment is required for Brucella spondylitis that has caused neurological symptoms in the lower extremities and developed an intraspinal abscess. The main purpose of surgery is to remove the lesion and restore the stability of the spine. However, both the anterior approach and the posterior approach cannot completely remove the lesions, resulting in a low cure rate and a certain recurrence rate. Although anterior or posterior debridement is more thorough, it is unbearable for some patients with poor general condition. In this study, for the first time, a negative pressure wound therapy (NPWT) device was introduced into the intervertebral space through the extreme lateral approach to treat a patient with Brucella spondylitis. We summarize the treatment process, and discuss the feasibility and effectiveness of this surgical approach through 1-year follow-up.

Comparison of two surgical interventions for lumbar brucella spondylitis in adults: a retrospective analysis

“…This positive surgical intervention aims to alleviate pain, eradicate the infectious focus, ameliorate neurological dysfunction, correct spinal deformity, and restore spinal stability 11 , 24 . Thus, in accordance with relevant literature 5 , 17 , 20 , 21 , 26 , 29 , 30 , we propose the following indications for surgical intervention in the treatment of brucellosis spondylitis: (1) definite diagnosis of brucellosis spondylitis and completion of two standard courses of chemotherapy, resulting in improvement of systemic toxicity symptoms but no alleviation or even exacerbation of severe low back pain. (2) severe intervertebral disc destruction and cartilage endplate defect with spinal instability or severe destruction and collapse of vertebral structures leading to spinal deformity; (3) vertebral canal abscess or inflammatory granuloma compressing the spinal cord, cauda equina, or nerve roots, causing significant neurological symptoms.…”

Effect of closed suction irrigation on patients with brucellosis spondylitis after one-stage posterior debridement and bone grafting fusion with internal fixation: a randomized controlled trial

“…When conservative treatment fails, spinal abscess, spinal collapse, bone destruction, spinal cord compression, radiculopathy or spinal instability, surgical treatment is necessary [3,12]. Although surgical treatment can effectively control the condition of patients, surgery can not completely ensure the complete removal of the focus, and the cure rate is low, which may lead to the recurrence of spinal infection [13]. Therefore, patients usually still receive regular antibacterial drugs after operation, with the aim of further controlling infection, relieving symptoms and preventing recurrence.…”

“…Therefore, patients usually still receive regular antibacterial drugs after operation, with the aim of further controlling infection, relieving symptoms and preventing recurrence. Commonly used drugs are streptomycin, rifampicin, doxycycline, trimethoprim/sulfamethoxazole, cipro oxacin and gentamicin [13], and the recommended scheme includes the combination of two or three antibiotics. However, conventional oral antibiotics drug therapy has the characteristics of long cycle and easy drug resistance, which increases the occurrence of adverse reactions, leads to prolonged hospitalization time, increases the economic burden of patients [15,16], and the poor compliance of patients.…”