Imageology In Staging And Treatment Efficacy Of Transforaminal Lumbar Interbody Debridement And Fusion For Brucella Spondylitis In Lumbar Spine

Objective:The aim of the study is to improve the diagnostic accuracy of lumbar brucella spondylitis by summarizing the imaging features of the disease in different stages,and evaluate the clinical feasibility and effectiveness of Transforaminal Lumbar Intervertebral Body Debridement and Fusion(TLIDF)surgery to treat the disease.Method:22 patients who received TLIDF surgery in orthopedic surgery department of our hospital because of the spinal brucellosis from February 2010 to June 2013 were recruited in our study,and lumbar X-rays,CT and MRI were carried out before surgery.Furthermore,all of patients were treated by doxycycline at least for 3 weeks before surgery and another 6 months post-surgery.All patients received a carefully designed follow-up plan at 3,6,and 12 months after the surgery,and once every 6 months afterwards.The follow up parameters included complications and relapse of brucellosis evaluation,ESR and CRP levels,backache and lower extremity neuralgia symptoms improvements evaluation using Visual Analogue Scales(VAS)and Oswestry Disability Index(ODI).SPSS19.0 statistical software was used to analyze the data.Result:The progression of Brucellosis spondylitis on imageology is divided into three phases:?Early Stage:No abnormality seen in X-ray and CT,but high signals could be detected in vertebral body and paravertebral area by MRI;?Middle Stage:Lumbar X-ray showed the degenerative changes.Disc height could be normal or a little narrow.Small osteolytic lesions,hyperplastic,sclerosis and protrusion of intervertebral disc could be found in CT.MRI revealed inflammatory signals in lumbar vertebrae and intervertebral disc,and localized abscess in lumbar vertebrae and intervertebral disc.?Late Stage:X-ray showed obvious narrow of disc height,unclear endplate,vertebral body osteophyte;CT showed sclerosis,osteolytic and inflammatory osteophytosis co-exists in the vertebral body;MRI showed inflammatory signal in intra-spinal and/or para-spinal areas following with extensive abscesses formation.All the patients in the study showed paraspinal or spinal epidural abscess,destruction of the disc,and/or inflammatory granulation tissue into the spinal cord compression spinal cord,cauda equina or nerve root.According to the imaging characteristics,20 patients received TLIDF surgery,1 patient underwent a revision TLIDF surgery,and 1 patient received TLIDF plus anterior papillary muscle abscess removal surgery.All wounds healing were first intention without sinus and blood vessels and nerve damage.Meanwhile,no relapse was observed during follow-up in all patients.One week before the operation,average Erythrocyte Sedimentation Rate(ESR)was 37.7 ± 25.4 mm/h,and average C-reactive protein(CRP)was 33.1 ± 29.3 mg/L.In contrast,one week later after surgery,average ESR was 48.7±26.4mm/h and average CRP was 51.5 ± 44,1 mg/L,both of which were significantly higher than that before surgery(p<0.05).However,three months after surgery,average ESR and CRP were 11.4 ± 6.3 mm/h and 9.6 ± 7.4 mg/L respectively,which were obviously deceased compared with pre-surgery and one week post-surgery(p<0.05).VAS were much lower post-surgery compared with pre-surgery(2,66 ± 1.04 and 6.82 ± 2.14 respectively,p<0.05).Similar with VAS,ODI score was 8.82 ± 1.73,significantly decreased as compared with that before surgery(35.72±1.91)(p<0.05).Conclusions:Brucella spondylitis lumbar disease in different stages has their own characteristics in the image,so the disease can be divided into early,middle and late phases.It is hard for X-ray to show the slight lesions and paraspinal soft tissues in the early stage.Whereas,CT,especially three dimensional reconstructive CT could show the shape of vertebral bone destruction clearly in the early stage because of the high resolution.Abnormal signals of vertebral bodies and paraspinal soft tissues could be detected before morphological changes indicating MRI is more sensitive.Based on medicine thrapy,TLIDF surgery could clear the lesion out and retain spine posterior complex.Moreover,the pedicle screw fixation system can reconstruct the stability of the spine and provide a stable mechanical environment.Thus,TLIDF surgery is an effective surgical approach to eliminate symptoms and cure the disease.