Clinical Efficacy Of One-stage Unilateral And Bilateral Fenestration In The Treatment Of Lumbosacral Brucellosis Spondylitis

Objective : To retrospectively analyze the application of one-stage unilateral and bilateral fenestration,debridement,interbody fusion combined with posterior instrumentation in the treatment of lumbosacral brucellosis spondylitis,compare the clinical efficacy of the two,and provide a scientific basis for later clinical treatment.Methods:We retrospectively analyzed the patients with lumbosacral brucellosis spondylitis who underwent fenestration,debridement,interbody fusion combined with posterior instrumentation in our hospital from June 2011 to June 2017.A total of 48 patients were enrolled in this study.According to the surgical method,they were divided into two groups.In the unilateral group,27 cases of one-stage posterior unilateral fenestration,debridement,interbody fusion combined with posterior instrumentation were performed,23 males and 4 females,aged 23-71 year;In the bilateral group,21 cases of one-stage posterior bilateral fenestration,debridement,interbody fusion combined with posterior instrumentation were performed,aged 26-58 years.There were 17 males and 4females.The preoperative and postoperative clinical symptoms,neurological function,C-reactive protein,the surgery duration time,the blood loss,and erythrocyte sedimentation rate were observed.The internal fixation device was evaluated for looseness and fracture by imaging examination.The Bridwell classification criteria were used to evaluate the bone graft fusion.As well as assessing postoperative complications.Results:All patients were followed up for a mean follow-up of 23.7±6.3 months.Comparison within the group: the last C-reactive protein,erythrocyte sedimentation rate,VAS,ODI and JOA scores were significantly improved(P<0.05).Comparison between groups: Therewas no statistical difference between the two groups(P>0.05).The difference in operation time and intraoperative blood loss between the two groups was statistically significant(P <0.05).The postoperative lumbar and leg pain were significantly relieved.One patient in the bilateral fenestration group developed a wound infection,and after half a month,debridement and drainage were performed,and the patient eventually recovered.There was no significant difference in the time of bone graft fusion between the two groups(P>0.05),and they were completely fused at the last follow-up.Cunclusion: Unilateral and bilateral fenestration,debridement and bone graft fusion and internal fixation for the treatment of lumbosacral brucellosis spondylitis can achieve good clinical results,and the former has the advantages of short operation time and low cost.