To evaluate the clinical efficacy of patients with brucellar spondylitis(BS), who were treated with limited lesion clearance posterior internal fixation combined with individualized medication therapy.

From June 2014 to January 2019, 44 patients with BS who were admitted to the First Affiliated Hospital of Hebei North University and met the inclusion criteria were selected, including 26 males and 18 females. Pathological entity: T₁₁/T₁₂ 2 cases; T₁₂/L₁ 8 cases; L₃/L₄ 6 cases; L₄/L₅ 20 cases; L₅/S₁ 8 cases.Visual alnalogue scale (VAS) of waist and back, C-Reactive protein(CRP), erythrocyte sdimentation rate(ESR) were checked before surgery, and the bengal plate agglutination text and serum tube agglutination test were positive. Before surgery, 16 patients were associated with neurological symptoms, including 6 patients with grade C and 10 patients with grade D according to American spinal injury association (ASIA). Six patients were allergic to the first-line anti-brucella drug. Preoperative standardized drug therapy was performed. The dosage and frequency of the individualized drug were determined according to the individual′s physical condition, nutritional status and liver and kidney function, and the operation of posterior internal fixation was performed after limited lesion removal. After the operation, the patient continued to receive individualized treatment or adjusted the sensitive antibiotics according to the results of drug sensitivity test. The operation time, bleeding volume and related complications of all patients were observed and recorded. VAS, CRP, ESR, bengal plate agglutination text, serum tube agglutination test, X-ray examination were performed before surgery and after 3, 6 and 12 months of follow-up. MRI examination were performed after 6 and 12 months of follow-up. ASIA nerve functional rating evaluation was performed at the last follow-up. Data were processed with repeated measures analysis of variance and paired t test.

The operation process of all patients was smooth, the average operation time and bleeding volume were (2.2±0.2) h, (360±50) mL. Forty-four patients had good postoperative wound closure, no surgical complications occurred, and liver and kidney functions were not damaged at the last follow-up, all of which reached clinical cure. The VAS of 44 patients were (6.3±1.3), (2.3±0.8), 0, and 0 points at the time of before surgery and 3, 6, 12 months after surgery, respectively, the difference was statistically significant (F=64.26, P<0.05). CRP of 44 patients were (65.31±4.01), (4.31±0.12), (3.05±0.01), (1.33±0.12) mg/L at the time of before surgery and 3, 6, 12 months after surgery, respectively, the difference was statistically significant (F=226.13, P<0.05). The ESR of 44 patients were (54.78±3.12), (13.08±1.01), (6.21±1.32), (2.32±0.38) mm/h at the time of before surgery and 3, 6, 12 months after surgery, respectively, the difference was statistically significant (F=182.38, P<0.05). Comparison of VAS, CRP and ESR before surgery and 3 months after surgery, the differences were statistically significant (t=1.749, 5.763, 4.219; with P values below 0.05). Bengal plate agglutination text and serum tube agglutination test were negative at 3 months after surgery. The results of X-ray at 6 and 12 months after surgery showed that pedicle screws were strong, the spine was stable, and intervertebral bone grafting was performed. At the 6 and 12 months after surgery, MRI showed that the vertebral body and paravertebral tissue showed inflammatory absorption, and the spinal cord in the spinal canal showed no compression. Preoperative ASIA neurological function grading was grade C in 6 cases, and postoperative improvement was grade D in 2 cases, and grade E in 4 cases. There were 10 patients with grade D before surgery and all were improved to grade E after surgery.

Limited lesion clearance posterior internal fixation combined with individualized medication therapy is safe and feasible for BS to control infection, rational medication, eliminate inflammation, relieve pain, relieve spinal nerve compression, and promote rapid recovery. The clinical effect is satisfactory.