Transforaminal debridement and interbody fusion in lumbar Brucella spondylitis

English Keywords:Brucella spondylitis  Lumbar  Transforaminal lumbar intervertebral body debridement and fusion

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical feasibility and outcomes of transforaminal debridement and interbody fusion(TLIDF) to treat lumbar Brucella spondylitis. Methods: Twenty-eight patients with lumbar Brucella spondylitis who received TLIDF from February 2010 to June 2015 in our hospital were recruited in the study, conservative treatment was invalid in these patients. Among them, twenty-seven patients received TLIDF, one patient received TLIDF plus abscess removal in anterior papillary muscle. All the patients accepted anti-Brucella drugs for 6 weeks after operation and regular follow-up. Surgical results were evaluated clinically and radiographically, clinical outcomes included: erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) before operation, one week after operation and at the last follow-up; lumbar/lower limb pain visual analogue scale(VAS) and Oswestry disability index(ODI) before operation and at the last follow-up. The radiographical outcomes included bone fusion assessed in lumbar X-ray and CT, lumbar infection, abscess and inflammatory assessed in MRI. SPSS 19.0 statistical software was used in the study. Results: All wounds healed primarily without sinus and neurovascular injury. Before operation, the average ESR was 39.3±24.9mm/h, and the average CRP was 36.2±27.6mg/L. At one week after surgery, the average ESR was 49.8±21.6mm/h and the average CRP was 53.1±22.1mg/L, both of which were significantly higher than those before operation(P<0.05). However, at the last follow-up, the average ESR and CRP were 9.4±5.8mm/h and 6.1±3.4mg/L, which obviously deceased when compared with those before operation and at one week after operation(P<0.05). Lumbar and lower limb VAS were much lower postoperatively when compared with those preoperatively(6.28±1.36 vs 2.53±1.26, 6.74±2.83 vs 2.05±1.35). The preoperative and postoperative ODI scores were 37.59±5.85 and 7.59±2.17, which had significant difference(P<0.05). Meanwhile, no relapse was observed during follow-up in all patients. Conclusions: TLIDF can effectively remove the lesions of brucella spondylitis and reconstruct the stability of spinal column. With the drug therapy, it can achieve satisfactory clinical outcomes.