Abstract:

Objective To investigate the surgical efficacy of posterior lumbar interbody fusion (PLIF) in treating lumbar Brucellar spondylitis patients with single-segment involvement.Methods The clinical data were collected from 67 lumbar Brucellar spondylitis patients with single-segment involvement who received PLIF surgery in Xinjiang Uygur Autonomous Region Chest Hospital from January 2010 to January 2015. Among them, 49 patients were male, and 18 were female. The mean age was (49.9±13.0) years. There were 24 cases with Frankel Grade E, 24 with Grade D, and one with Grade C before the surgery. Under general anesthesia, all patients underwent posterior pedicle screw fixation, unilateral laminectomy and fenestration, debridement, and autologous bone interbody fusion. Patients were followed up postoperative. The visual analogue scale score (VAS) and Frankel classi-fication were evaluated, rythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured, and Brucella serum agglutination test was conducted. Also, frontal and lateral X-ray and CT scan were performed to assess the extent of postoperative bone graft healing.Results All of the 67 patients were confirmed Brucella infection by postoperative pathology. The mean operation time was (101±23) minutes and the mean blood loss was (95.22±56.87) ml. No spinal cord, nerve and blood vessel injury occurred during operation. Three to 7 days after surgery, frontal and lateral X-ray results showed no loosening of the internal fixation and good position of the bone graft. Three patients experienced (cerebrospinal fluid) CSF leakage after operation, but all were cured after 2 weeks of treatment. The patients were followed up for 9 to 24 months. At the last follow-up, no internal fixation was loosened, and no nail or rod was broken. No patient recurred. There was no delayed healing and sinus formation. The VAS score was (7.16±0.91) before surgery, and (4.19±0.92), (3.06±0.92), (1.48±0.59) and 0 at 1-, 3-, 6- and 12-month time-point after surgery; significant improvement in VAS score was observed after operation at different time points (F=355.95, P<0.01). The ESR and CRP levels became normal 6 months later after operation. The result of Brucella serum agglutination test 9 months postoperatively indicated that all patients became negative. Frontal and lateral X-ray and CT scan showed that all patients achieved good bone graft fusion. According to the Bridwell criteria for postoperative graft bone healing, all patients achieved Grade I. The neurological function was significantly improved: the Frankel’s Grade was restored from Grade C to E in one patient and from Grade D to E in 24 patients.Conclusion PLIF is a safe and effective method in treating lumbar Brucellar spondylitis.

Key words: Brucella, Spondylitis, Surgical procedures, operative, Treatment outcome, Data interpretation, statistical