The Surgical Treatment of Lumbar Brucellar Spondylitis Byposterior Approach
Author(s): Tian Ye, Yang Xinming
Objective: This study investigate the effect of surgical treatment of lumbar spondylitis, which used posterior approach to remove the lesion, graft the bone between transverse process and used nail rod system to make Internal fixation.
Methods: From February 2011 to April 2017, 62 cases of lumbar brucellar spondylitis were analyzed retrospectively in the No. 1 Affiliated Hospital of Hebei North University in Zhangjiakou City, Hebei Province, China. Including 37 male and 25 female patients aged 24 to 61; average age was (42.8 ± 1.5). With an average duration of 4-28 months, average month was (6.6 ± 1.8). All the patients have the history of contact the source of animal, impurity diet history or other pathogen exposure history. The result of X-ray, CT, MRI, c-reactive protein and blood sedimentation, rose bengal plate agglutination test(RBPT) and standard tube agglutination test(SAT) check were positive. The outcome also conforms to National Health and Family Planning Commission of the People`s Republic of China WS 269-2007 brucellosis diagnostic criteria and principles of treatment. Preoperative, doxycycline + rifampicin + sulfamethoxazole were used for 56 days. Next, Surgical treatment was performed by using posterior approach to remove the lesion, graft the bone between transverse process and used nail rod system to make Internal fixation. Post-operative, the anti-bulimia drugs was used again until the C-reactive protein, blood pressure, RBPT test and the SAT test were negative. Furthermore, other 2 weeks medication should be used necessary. During drugs oral therapy time, the monitoring indexes of related infections were dynamically rechecked to monitor liver and kidney function. Visual analogue scale (VAS) was used to assess the degree of lower limb pain and lower back pain and Oswestry disability index (ODI) was used to assess the degree of recovery of waist function, Frankel spinal cord injury classification method was used to determine the recovery of spinal cord function.
Results: The operation time was 165-235 min, averaging (175.3 ± 22.1) min. Intraoperative bleeding was 260 ~ 510ml, averaging (338.3 ± 75.9) ml. The length of hospitalization was 8 ~ 14days, on average (11.99 ± 3.25) days. No intraoperative vascular injury or spinal cord injury. The incisions were healed well. The follow-up postoperative was more than 12 months, averaging month is 18.2 ± 4.5. The infection symptoms disappeared. After 3 months, the blood sedimentation and other infection indexes were returned to normal. The result of X-ray examination showed that bone healing was obtained in transverse process between 3 ~ 12 months, and the fusion time of bone graft was 7 ~ 11 months, average month is (8.4 ± 1.2). After 3 months, 6 months and 12 months follow-up, VAS score points was (3.05 ± 0.65), (1.88 ± 0.55) and (0.31 ± 0.42) respectively. Compared with preoperative points (6.67 ± 1.85), which is significantly lower. The results was statistically significant (P = 0.012); the classification of Frankel spinal cord injury was significantly better than before (P=0.022). The ODI functional disorder index was (21.15 ± 5.35), (12.26 ± 4.55) and (5.31 ± 3.12), lower than preoperative significantly (37.87 ± 4.85), and the results were statistically significant (P=0.031).
Conclusion: We could remove the lesion, graft the bone between transverse process and use nail rod system to make internal fixation by posterior approach, thoroughly remove the lesion which was granulation tissue or abscess of lumbar spine or around the spinal canal. For the vertebral canal and nerve root canal, a complete decompression can be created. After using nail rod system to make internal fixation, the lumbar spine could have an immediately stabilized. This method could recover the normal physiological protuberance of lumbar spine and prevent the instability occur in lumbar spine. For lumbar Brucella spondylitis, combine with long time oral therapy and posterior approach operation was an effective treatment method.