Clinical efficacy analysis of one-stage posterior debridement, bone graft fusion, and internal fixation for the treatment of lumbar brucellosis spondylitis

Abstract

Objective: To evaluate the clinical efficacy of one-stage posterior debridement with bone grafting, fusion, and internal fixation in the treatment of Brucellosis Spondylitis.

Methods: A retrospective analysis was conducted on 45 patients (30 males and 15 females) with lumbar Brucellosis Spondylitis who met the inclusion criteria and were treated at the Department of Spinal Orthopedics, General Hospital of Ningxia Medical University between January 2010 and February 2025.Patients ranged in age from 30 to 74 years (mean 52.7 ± 10.4 years) and had spinal lesions involving no more than two segments between T12 and S1. All patients received strict oral anti-brucellosis medication before and after surgery, and underwent one-stage posterior debridement with bone grafting, fusion, and internal fixation. Clinical parameters including hospital stay duration, operative time, intraoperative blood loss, and postoperative drainage volume were recorded. Follow-up assessments included Visual Analog Scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores for low back pain, ASIA impairment scale for neurological function, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), standard agglutination test (SAT), kyphotic Cobb angle of the affected segments, and postoperative complications such as implant loosening or rod fracture at various time points before and after surgery.

Results: All 45 patients achieved surgical site healed primarily without cerebrospinal fluid leakage or neurological complications. Within one week after the surgery, mild activities (such as standing beside the bed and short-distance walking) can be performed with the aid of a brace to promote blood circulation and prevent complications, with significant improvement in low back pain and neurological symptoms. All patients with preoperative neurological deficits recovered to ASIA grade E by 24 months postoperatively. Significant improvements (P < 0.05) were observed in mean VAS scores, JOA scores, ESR, CRP levels, and Cobb angles at all postoperative time points compared to preoperative values. At final follow-up, all patients demonstrated SAT titers below 1:160. The bone fusion rate reached 91.11% (41/45) according to Bridwell's classification criteria. Based on the modified MacNab criteria, the excellent and good rate was 95.56% (43/45). No cases of disease recurrence, implant loosening, or rod/screw breakage were observed during the follow-up period.

Conclusion: For lumbar Brucellosis Spondylitis, one-stage posterior debridement with bone grafting, fusion, and internal fixation, when combined with standardized pharmacological treatment, represents an effective therapeutic approach. This comprehensive treatment strategy facilitates thorough lesion eradication, improves spinal function, and achieves satisfactory clinical outcomes.

Keywords: Brucellosis spondylitis; Debridement; Internal fixation; Lumbar spine; Posterior approach.

Fig. 1

Line Graph Illustrating Mean VAS Scores and JOA Scores in 45 Patients: Preoperative and Postoperative Comparisons

Fig. 2

Preoperative/postoperative CRP line chart and ESR variable box chart of 45 patients

Fig. 3

Preoperative/postoperative cobb Angle variables of patients

Fig. 4

Pathological pictures

Fig. 5

A: Preoperative X-rays; B,C: Preoperative CT scan with reconstruction; D,E: Preoperative MRI; F: 3-month postoperative radiograph; G:3-month postoperative CT scan with reconstruction; H: Final follow-up anteroposterior and lateral radiographs; I: Final follow-up CT scan with reconstruction; J: Final follow-up MRI

Fig. 6

A: Preoperative X-rays; B: Preoperative MRI; C: Preoperative enhanced MRI; D: X-ray film 1 month after surgery; E: CT plain scan + reconstruction 3 months after surgery; F: Radiographs 3 months after surgery; G: Lumbar anterolateral and lateral radiographs 1 year after surgery; H, I: CT plain scan + reconstruction 1 year after surgery; J: MRI was followed up 1 year after surgery