Observation on the efficacy of one-stage posterior focus debridement, decompression, fusion and internal fixation in the treatment of senile brucellosis spondylitis

English Keywords:Brucellosis spondylitis  Posterior focus debridement, decompression, fusion and internal fixation  Senile  Efficacy

English Abstract:

  【Abstract】 Objectives: To observe the preliminary effect of one-stage posterior focus debridement, decompression, fusion and internal fixation in the treatment of senile brucellosis spondylitis. Methods: A retrospective analysis was made on the clinical data of 19 senile patients(≥65 years) with brucellosis spondylitis treated in the Department of Orthopedics, Beijing Ditan Hospital affiliated to Capital Medical University from April 2015 to August 2021. There were 14 males and 5 females, aged 67.9±2.4 years(65-73 years), and the course of disease was 10.8±2.7 months(7-16 months). 14 cases had a history of contact with cattle and sheep, 3 cases had a history of eating raw beef and mutton, and 2 cases had a history of drinking milk or goat′s milk. All the patients had symptoms of low back pain, including 3 with fever and 16 with lower limb pain/numbness; according to the American Spinal Injury Association(ASIA) impairment scale, 9 cases were of grade C, 7 cases of grade D and 3 cases of grade E. Imaging examination showed that the segments involved were: L1-2 in 1 case, L2-3 in 1 case, L3-4 in 7 cases, L4-5 in 7 cases, L5-S1 in 1 case, L1-2+L5-S1 in 1 case and L3-S1 in 1 case; the segmental intervertebral space of spinal lesions was narrow in all the patients, including 18 cases of lumbar instability of diseased segments, 17 cases of prevertebral beak-like spur, 17 cases of "lace vertebra", 16 cases of epidural abscess and 3 cases of psoas muscle abscess. The visual analogue scale(VAS), Oswestry disability index(ODI), erythrocyte sedimentation rate(ESR), and C-reactive protein(CRP) before operation in the 19 patients were 7.05±0.97, (42.05±2.61)%, 55.84±4.53mm/h, and 46.47±3.25mg/L respectively. On admission, 13 cases were complicated with hypertension, 14 cases with diabetes, 8 cases with coronary heart disease and 16 cases with hypoproteinemia. Active systemic support therapy was given during the perioperative period by treating the patients with rifampicin, doxycycline and levofloxacin for more than 2 weeks before and after operation and giving oral administration of rifampicin and doxycycline for six months after discharge. The low back and leg pain VAS, lumbar ODI, ESR, and CRP at 1 month, 3 months, 6 months and 12 months postoperatively were calculated, ASIA grading, and bone graft fusion were calculated at final follow-up, intraoperative and postoperative complications were also counted. Results: All the patients underwent operation smoothly. The operation time was 192.11±35.92min(150-300min) and the intraoperative blood loss was 527.37±108.09ml(400-800ml). The low back and leg pain VAS, lumbar ODI, ESR, and CRP decreased significantly at 1 month, 3 months, 6 months and 12 months postoperatively compared with the preoperative ones(P＜0.05). The infection indexes of ESR and CRP all returned to normal at 6 months postoperatively, the differences of ESR and CRP respectively between 6 months and 12 months postoperatively were not statistically significant. The patients were followed up for 17.53±3.15 months(12-24 months) after surgery, and 9 cases of ASIA grade C before operation recovered to grade D in 1 case and grade E in 8 cases at the last follow-up; and 7 cases of ASIA grade D all recovered to grade E at the last follow-up. All the patients had no obvious complications during and after operation, and satisfactory bone fusion was obtained at the last follow-up. Conclusions: For senile patients with brucellosis spondylitis, one-stage posterior focus debridement, decompression, fusion and internal fixation has a satisfactory effect on the basis of perioperative symptomatic support treatment and anti-infective treatment, which can effectively promote focal inflammatory repair and neurological function recovery.