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Zhang T, Ma L, Liu H, Zhang L, Yang C, Li S. Clinical characteristic, management, and outcomes of cervical spinal brucellosis: a retrospective cohort study over 1-year postoperative follow-up. J Orthop Surg Res 2024; 19:378. [PMID: 38937747 DOI: 10.1186/s13018-024-04868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The incidence of cervical spinal brucellosis is low, only a few case reports have been published, and case series are not widely reported in the medical literature. Therefore, clinical features, management, and outcomes of cervical spinal brucellosis are relatively unknown. In this series, the authors report 15 cases of patients with cervical spinal brucellosis, including clinical characteristic, imaging findings, management plans, the institution's experience, and outcomes at 1 year postoperatively. METHODS The study reviewed the clinical and radiographic records of 15 patients who received antimicrobial pharmacotherapy, and anterior cervical debridement and fusion for cervical spinal brucellosis. The data collected included patient demographic characteristics, spinal level affected, abscess, neurology, pathological reports, duration and type of antimicrobial regimens, details of orthopedic management, and complications incurred during the procedure. RESULTS Neck pain (100%) and limb paralysis (86.7%) were the most common clinical presentations, and the disease had a rapid progression. The C6-7 segment was the most commonly affected segment, followed by C4-5 and C5-6. Imaging commonly revealed epidural or paravertebral abscesses (80%). There was a significant improvement in the VAS, JOA, and NDI scores three months after surgery, and the scores continued to improve until the final follow-up. There was a statistically significant difference between the pre- and postoperative scores (P < 0.05). The ESR and CRP levels returned to normal within three months postoperatively, being 7.7 ± 4.5 mm/h and 7.55 ± 3.48 mg/L, respectively. There were statistically significant differences between the pre- and postoperative levels (P < 0.05). The positive rate of bacterial culture testing of pus or lesion tissues was only 40%, but blood cultures revealed an even lower positivity rate (33.3%). The average antimicrobial pharmacotherapy regimen duration was 6.1 ± 1.9 months. All patients achieved intervertebral bone fusion within 8 months (4.8 ± 1.4 months) after surgery and were cured with non-recurrence. CONCLUSIONS Spinal brucellosis rarely affects the cervical region, but its impact is more dangerous due to potential complications such as paraplegia or tetraplegia arising from epidural abscesses that compress the spinal cord. Surgical debridement, along with essential antimicrobial therapy, is an effective strategy and can lead to satisfactory prognosis in managing cervical spinal brucellosis.
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Affiliation(s)
- Tao Zhang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, Gansu, China
| | - Lihua Ma
- The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Hua Liu
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, Gansu, China
| | - Lian Zhang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, Gansu, China
| | - Chengwei Yang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, Gansu, China
| | - Songkai Li
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, Gansu, China.
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Wu T, Liu D, Meng F, Lu J, Fan Z. Full-Endoscopic Transforaminal Debridement and Decompression for Brucellar Thoracic Spinal Epidural Abscess: A Minimally Invasive Alternative to Open Surgery. Orthop Surg 2024; 16:1480-1486. [PMID: 38664222 PMCID: PMC11144516 DOI: 10.1111/os.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE Thoracic spinal epidural abscess (SEA) is a rare but dangerous condition, and traditional surgical methods are accompanied by extensive trauma and approach-related complications. Here we introduce the technique of full-endoscopic transforaminal debridement and decompression and evaluate its feasibility for treating brucellar thoracic SEA. METHODS We performed thoracic full-endoscopic transforaminal decompression and debridement on two patients with neurological deficits caused by brucellar SEA, which is mainly composed of granulation tissue rather than pus. Postoperative MRI was conducted to confirm the presence of any residual abscess compressing the nerves. Frankel grading was employed to assess the recovery of neurological function, and complications were documented. RESULTS There were no occurrences of dural tear, postoperative hematoma, or pulmonary complications. Their neurological function had significantly improved after surgery, and postoperative MRI confirmed no residual abscess compressing the spinal cord. During the 2-year follow-up, one patient achieved complete recovery (from Frankel-C to Frankel-E), while another patient improved from Frankel-A to Frankel-D. Neither patient experienced infection recurrence, instability, nor kyphotic deformity. CONCLUSION We described the novel application of transforaminal endoscopic surgery in brucellar thoracic granulomatous SEA and preliminarily indicated the feasibility of this technique as a minimally invasive alternative to open surgery.
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Affiliation(s)
- Tong Wu
- Department of OrthopedicsShengjing Hospital of China Medical UniversityShenyangChina
| | - Da Liu
- Department of OrthopedicsShengjing Hospital of China Medical UniversityShenyangChina
| | - Fan‐he Meng
- Department of OrthopedicsShengjing Hospital of China Medical UniversityShenyangChina
| | - Jing‐han Lu
- Department of OrthopedicsShengjing Hospital of China Medical UniversityShenyangChina
| | - Zheng Fan
- Department of OrthopedicsShengjing Hospital of China Medical UniversityShenyangChina
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Liu C, Liu Q, Zheng J, Niu N, Shi J, Yang Z. Selection of treatment strategies for lumbar Brucella spondylitis: a retrospective clinical study. Front Surg 2024; 11:1365498. [PMID: 38596166 PMCID: PMC11003786 DOI: 10.3389/fsurg.2024.1365498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
Objective This study aims to investigate the treatment strategies for lumbar brucellar spondylitis by comparing the outcomes of pure pharmacological treatment with diseased intervertebral fixation fusion, with or without lesion clearance. Methods A total of 157 patients with lumbar brucellar spondylitis were categorized into three groups: Group A (52 cases) received pure pharmacological treatment, Group B (53 cases) underwent posterior vertebral fixation fusion, and Group C (52 cases) received posterior (or anterior) lesion clearance followed by posterior vertebral fixation fusion. Clinical data were analyzed, and the efficacy of the three treatment methods was evaluated. Results The surgical groups showed better outcomes at various time points compared to the pharmacological treatment group (P < 0.05). The pure fixation group outperformed the lesion clearance fusion group during the perioperative period (P < 0.05). The ESR, CRP, ODI scores, imaging evaluation and complications of the lesion clearance followed by fixation group were all better than those of the other two groups (P < 0.05). Surgical treatment groups showed no statistically significant difference in VAS scores (P > 0.05), and both were superior to the pharmacological treatment group. There were no statistically significant differences in clinical efficacy among the three groups at the last follow-up. Conclusion Surgical treatment achieves early recovery goals compared to pharmacological treatment for brucellar spondylitis. However, individualized treatment principles should guide surgical decisions to select the most suitable approach for patients.
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Affiliation(s)
- Changhao Liu
- Department of Orthopedics, Zhangye People’s Hospital Affiliated to Hexi University, Zhangye, Gansu, China
| | - Qiang Liu
- The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jianping Zheng
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ningkui Niu
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jiandang Shi
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zongqiang Yang
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Kou X, Xie W, Luo W, Wang N. Trauma accelerates Brucella invasion of the cervical spinal cord: A case report. Asian J Surg 2024; 47:1226-1228. [PMID: 38001002 DOI: 10.1016/j.asjsur.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Affiliation(s)
- Xianshuai Kou
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Wendong Xie
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Wenyuan Luo
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Neng Wang
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Spernovasilis N, Karantanas A, Markaki I, Konsoula A, Ntontis Z, Koutserimpas C, Alpantaki K. Brucella Spondylitis: Current Knowledge and Recent Advances. J Clin Med 2024; 13:595. [PMID: 38276100 PMCID: PMC10816169 DOI: 10.3390/jcm13020595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
The most prevalent zoonotic disease is brucellosis, which poses a significant threat for worldwide public health. Particularly in endemic areas, spinal involvement is a major source of morbidity and mortality and can complicate the course of the disease. The diagnosis of Brucella spondylitis is challenging and should be suspected in the appropriate epidemiological and clinical context, in correlation with microbiological and radiological findings. Treatment depends largely on the affected parts of the body. Available treatment options include antibiotic administration for an adequate period of time and, when appropriate, surgical intervention. In this article, we examined the most recent data on the pathophysiology, clinical manifestation, diagnosis, and management of spinal brucellosis in adults.
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Affiliation(s)
| | - Apostolos Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, 71500 Heraklion, Greece;
- Advanced Hybrid Imaging Systems, Institute of Computer Science, FORTH, 71500 Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Ioulia Markaki
- Internal Medicine Department, Thoracic Diseases General Hospital Sotiria, 11527 Athens, Greece;
| | - Afroditi Konsoula
- Department of Pediatrics, General Hospital of Sitia, 72300 Sitia, Greece;
| | - Zisis Ntontis
- Department of Orthopaedics and Trauma Surgery, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece;
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece;
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Trauma Surgery, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece;
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Miyoshi IC, de Toledo AHN, Pereira FV, Villarinho LDL, Dalaqua M, de Ávila Duarte J, Reis F. Infectious Myelitis. Semin Ultrasound CT MR 2023; 44:424-435. [PMID: 37555684 DOI: 10.1053/j.sult.2023.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Myelitis is an extensive group of pathologies, including inflammatory, demyelinating, and infectious disorders, sometimes mimicking tumors. This article will discuss infectious myelitis, mainly the patterns of spinal cord involvement caused by each infectious agent and the contribution of magnetic resonance imaging as a major tool to establish the specific diagnosis.
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Affiliation(s)
| | | | | | | | - Mariana Dalaqua
- Departement d'Imagerie Médicale, Réseau Hospitalier Neuchatelois, Pourtalès, Switzerland
| | - Juliana de Ávila Duarte
- Department of Radiology and Diagnostic Imaging, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Fabiano Reis
- Medicine Department of Anesthesiology, Oncology and Radiology, UNICAMP, Campinas, SP, Brazil.
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Yang X, Jiao C, Liu X, Zhang Y, Zhou H, Wang Y. Coexistence of cryoglobulinemia and ANCA-associated vasculitis in a chronic brucellosis patient -a case report and literature review. BMC Infect Dis 2023; 23:272. [PMID: 37131122 PMCID: PMC10152744 DOI: 10.1186/s12879-023-08232-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/06/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The renal involvement of brucellosis is not common. Here we reported a rare case of chronic brucellosis accompanied by nephritic syndrome, acute kidney injury, the coexistence of cryoglobulinemia and antineutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis (AAV) superimposed on iliac aortic stent implantation. The diagnosis and treatment of the case are instructive. CASE PRESENTATION A 49-year-old man with hypertension and iliac aortic stent implantation was admitted for unexplained renal failure with signs of nephritic syndrome, congestive heart failure, moderate anemia and livedoid change in the left sole with pain. His past history included chronic brucellosis and he just underwent the recurrence and completed the 6 weeks of antibiotics treatment. He demonstrated positive cytoplasmic/proteinase 3 ANCA, mixed type cryoglobulinemia and decreased C3. The kidney biopsy revealed endocapillary proliferative glomerulonephritis with a small amount of crescent formation. Immunofluorescence staining revealed only C3-positive staining. In accordance with clinical and laboratory findings, post-infective acute glomerulonephritis superimposed with AAV was diagnosed. The patient was treated with corticosteroids and antibiotics and sustained alleviation of renal function and brucellosis was achieved during the course of a 3-month follow-up. CONCLUSIONS Here we describe the diagnostic and treatment challenge in a patient with chronic brucellosis related glomerulonephritis accompanied by the coexistence of AAV and cryoglobulinemia. Renal biopsy confirmed the diagnosis of postinfectious acute glomerulonephritis overlapping with ANCA related crescentic glomerulonephritis, which was not ever reported in the literature. The patient showed a good response to steroid treatment which indicated the immunity-induced kidney injury. Meanwhile, it is essential to recognize and actively treat the coexisting brucellosis even when there are no clinical signs of the active stage of infection. This is the critical point for a salutary patient outcome for brucellosis associated renal complications.
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Affiliation(s)
- Xu Yang
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Congcong Jiao
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Xiaomei Liu
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Yongzhe Zhang
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Hua Zhou
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Yanqiu Wang
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China.
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Qiangsheng F, Xiaoqin H, Tong L, Wenyun G, Yuejuan S. Brucella cultures characteristics, clinical characteristics, and infection biomarkers of human Brucellosis. J Infect Public Health 2023; 16:303-309. [PMID: 36641837 DOI: 10.1016/j.jiph.2023.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/15/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Aim to investigate the brucella culture characteristics, diagnosis methods, and clinical characteristics, to provide the laboratory with diagnostic methods and prevention and treatment for brucellosis. METHODS Data of 328 cases of brucellosis from 2012 to 2022 was analyzed, retrospectively. The bacterial culture characteristics, the clinical diagnostic methods, and the complications were analyzed respectively. The infection biomarkers of the brucellosis were analyzed by Receiver operating characteristic curve ROC. RESULTS Among the 328 brucellosis, 78.96 % of cases were men, the median age of the patients was (45.21±13.49) years and the annual incidence in our region was 67/100 000 per year. The diagnostic methods included pathogenic bacteria culture, serological diagnosis, and suspect case were 24.39 %, 47.56 %, and 28.05 %, respectively, sensitivity of combined detection Standard agglutination test (SAT) and the Rose Bengal test (RBT) is 96.2 %. In our work, 80 cases of brucellosis were diagnosed by a bacterial culture which were been identified as Brucella melitensis, blood culture was the main method (78.75 %) and the average positive alarm time was 80.74 (21.6-129) h and all of them were detected in aerobic bottles, followed by synovial fluid, bone marrow, lumbar spine, and joint tissue, puncture fluid and ascites culture which were 6.25 %, 3.75 %, 5.00 %, 5.00 % and 1.25 % respectively. The brucellosis with complications was lumbar spine lesions at 41.46 % cervical spine lesions at 4.60 % and knee joint lesions at 12.8 % and another osteoarthritis. The in-hospital mortality rate of the patients was 0.91 % and all of them were meningitis patients. ROC analysis indicated CRP had high sensitivity and specificity for brucellosis, and when CRP was 1.23mg/ml, the sensitivity and specificity were 0.727 and 0.718 respectively, and the U test also indicated CRP had a significant difference, Z=5.054, p <0.001. CONCLUSIONS Brucellosis is frequently morbidity in 40 + age men, which has been diagnosed by aerobic blood culture, generally bacterial culture, RBT and SAT, epidemiological, and commonly with complications of spine and arthropathy.
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Affiliation(s)
- Feng Qiangsheng
- Department of Clinical Laboratory, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou 730050, China
| | - Ha Xiaoqin
- Department of Clinical Laboratory, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou 730050, China
| | - Lin Tong
- Department of Medica, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou 730050, China
| | - Guo Wenyun
- Department of Cardiology, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou 730050, China
| | - Song Yuejuan
- Department of Clinical Laboratory, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou 730050, China.
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Spinal Infections. Neuroimaging Clin N Am 2023; 33:167-183. [DOI: 10.1016/j.nic.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wang X, Long Y, Li Y, Guo Y, Mansuerjiang M, Tian Z, Younusi A, Cao L, Wang C. Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis. Front Surg 2023; 9:1024510. [PMID: 36684311 PMCID: PMC9852336 DOI: 10.3389/fsurg.2022.1024510] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/10/2022] [Indexed: 01/08/2023] Open
Abstract
Objective This study aims to investigate the effectiveness and feasibility of biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis (LBS). Methods The data of 13 patients with LBS were retrospectively analyzed, who underwent biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation from May 2020 to June 2022. The patients' clinical data, the duration of operation, the estimated blood loss (including postoperative drainage), and complications were recorded. Clinical outcomes include serum agglutination test (SAT) measures Brucella antibody titer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analog scale (VAS) scores of low back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), American Spinal Injury Association neurological classification, and lordotic angle were analyzed. All patients were assessed using the modified Macnab criteria at the final follow-up. The intervertebral bone graft fusion was assessed using the Bridwell grading criteria. Results The mean operation duration was 177.31 ± 19.54 min, and the estimated blood loss was 176.15 ± 43.79 ml (including postoperative drainage was 41.15 ± 10.44 ml). The mean follow-up period was 13.92 ± 1.5 months. SAT showed that the antibody titers of 13 patients were normal 3 months after the operation and at the final follow-up. ESR and CRP levels returned to normal by the end of the 3-month follow-up. VAS scores of low back and leg, JOA score, and ODI significantly improved after the operation throughout the follow-up period (P < 0.05). Based on the modified Macnab criteria, 92.3% showed excellent to good outcomes. One patient had only a percutaneous screw internal fixation on the decompression side due to severe osteoporosis. One case suffered a superficial incision infection postoperatively that healed with dressing change and effective antibiotic treatment. Bony fusion was obtained in all patients at the last follow-up, including 12 cases with grade I and 1 case with grade II, with a fusion rate of 92.31%. Conclusion Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation is an effective, safe, and viable surgical procedure for the treatment of LBS.
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Affiliation(s)
- Xiangbin Wang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yubin Long
- Department of Spinal Surgery, Hunan Shaoyang Central Hospital, Shaoyang, China
| | - Yong Li
- Department of Spinal Surgery, Hunan Shaoyang Central Hospital, Shaoyang, China
| | - Yun Guo
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Maiwulan Mansuerjiang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zheng Tian
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Aikebaier Younusi
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Cao
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China,Correspondence: Chong Wang Li Cao
| | - Chong Wang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China,Correspondence: Chong Wang Li Cao
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Maamari J, Tande A, Diehn F, Tai DBG, Berbari E. Diagnosis of vertebral osteomyelitis. J Bone Jt Infect 2022; 7:23-32. [PMID: 35136714 PMCID: PMC8814828 DOI: 10.5194/jbji-7-23-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Native vertebral osteomyelitis (NVO) is a potentially fatal infection which
has seen a gradual increase in its incidence over the past decades. The
infection is insidious, presenting with symptoms of back pain. Fever is
present in about 60 % of patients. Prompt diagnosis of NVO is important to
prevent the development of complications. Numerous laboratory and imaging
tools can be deployed to accurately establish the diagnosis. Imaging
techniques such as magnetic resonance, nuclear imaging, and computed
tomography are essential in diagnosing NVO but can also be useful in
image-guided biopsies. Laboratory tools include routine blood tests,
inflammatory markers, and routine culture techniques of aspirated specimens.
Recent advances in molecular techniques can assist in identifying offending
pathogen(s). In this review, we detail the arsenal of techniques that can be
utilized to reach a diagnosis of NVO.
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Affiliation(s)
- Julian Maamari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Aaron J. Tande
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Felix Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Elie F. Berbari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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Li Q, Liu J, Jiang W, Jiang L, Lu M, Xiao L, Li Y, Lan Y, Li Y. A case of brucellosis-induced Guillain–Barre syndrome. BMC Infect Dis 2022; 22:72. [PMID: 35057735 PMCID: PMC8781241 DOI: 10.1186/s12879-021-07025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022] Open
Abstract
Background Guillain–Barre syndrome (GBS) is a rare neurological complication of brucellosis, and neurobrucellosis is the most common, but they have many similarities in clinical manifestations. Many clinicians are accustomed to merely explaining the manifestations of nervous system involvement with neurobrucellosis, but they ignore the possibility of GBS, and this leads to misdiagnosis, untimely treatment, and serious consequences. Case presentation A 55-year-old male patient was admitted to The First Affiliated Hospital of Harbin Medical University for intermittent fever, fatigue, and waist pain more than three months. Brucellosis was diagnosed from the blood test. Although anti-brucella treatment was given at the time of diagnosis, the disease continued to progress. At the time of the cerebrospinal fluid systematic physical examination and the neuroelectrophysiological test, acute motor sensory axonal neuropathy was diagnosed. The patient was given immediately administered immunoglobulin therapy. After three months of systemic treatment, the patient's muscle strength of the distal limbs gradually recovered. The numbness of the limbs eased slowly, and urination function and respiratory function returned to normal. He could sit by himself. Conclusions The possibility of GBS should be closely monitored for when a brucellosis patient shows typical clinical manifestations of progressive muscle weakness, protein-cell separation of the cerebral spinal fluid, and typical demyelinating sensorimotor polyneuropathy.
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Ortiz AO, Levitt A, Shah LM, Parsons MS, Agarwal V, Baldwin K, Bhattacharyya S, Boulter DJ, Burns J, Fink KR, Hunt CH, Hutchins TA, Kao LS, Khan MA, Lo BM, Moritani T, Reitman C, Repplinger MD, Shah VN, Singh S, Timpone VM, Corey AS. ACR Appropriateness Criteria® Suspected Spine Infection. J Am Coll Radiol 2021; 18:S488-S501. [PMID: 34794603 DOI: 10.1016/j.jacr.2021.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 10/19/2022]
Abstract
Spine infection is both a clinical and diagnostic imaging challenge due to its relatively indolent and nonspecific clinical presentation. The diagnosis of spine infection is based upon a combination of clinical suspicion, imaging evaluation and, when possible, microbiologic confirmation performed from blood cultures or image-guided percutaneous or open spine biopsy. With respect to the imaging evaluation of suspected spine infection, MRI without and with contrast of the affected spine segment is the initial diagnostic test of choice. As noncontrast MRI of the spine is often used in the evaluation of back or neck pain not responding to conservative medical management, it may show findings that are suggestive of infection, hence this procedure may also be considered in the evaluation of suspected spine infection. Nuclear medicine studies, including skeletal scintigraphy, gallium scan, and FDG-PET/CT, may be helpful in equivocal or select cases. Similarly, radiography and CT may be appropriate for assessing overall spinal stability, spine alignment, osseous integrity and, when present, the status of spine instrumentation or spine implants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- A Orlando Ortiz
- Chairman, Department of Radiology, Jacobi Medical Center, Bronx, New York.
| | - Alex Levitt
- Research Author, Jacobi Medical Center, Bronx, New York
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Vikas Agarwal
- Vice-Chair of Education, Chief, Neuroradiology, and Director, Spine Intervention, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Keith Baldwin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, American Academy of Orthopaedic Surgeons
| | - Shamik Bhattacharyya
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts, American Academy of Neurology
| | - Daniel J Boulter
- Clinical Director, MRI, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Judah Burns
- Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | | | | | - Troy A Hutchins
- Chief Value Officer, Department of Radiology, University of Utah Health, Salt Lake City, Utah
| | - Lillian S Kao
- Chief, Division of Acute Care Surgery, The University of Texas Health Science Center at Houston, Houston, Texas; and American Association for the Surgery of Trauma
| | - Majid A Khan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Medical School, Norfolk, Virginia; Board Member, American Academy of Emergency Medicine; and American College of Emergency Physicians
| | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina; and Board of Directors, North American Spine Society
| | - Michael D Repplinger
- University of Wisconsin, Madison, Wisconsin; President, Dane County Medical Society; Councillor, American College of Emergency Physicians; and Society for Academic Emergency Medicine
| | - Vinil N Shah
- University of California San Francisco, San Francisco, California; and Executive Committee, American Society of Spine Radiology
| | - Simranjit Singh
- Indiana University School of Medicine, Indianapolis, Indiana; Secretary, SHM, Indiana Chapter; Secretary, SGIM, Midwest Region; and American College of Physicians
| | - Vincent M Timpone
- Co-Director, Neuroradiology Spine Intervention Service, Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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14
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Guo H, Lan S, He Y, Tiheiran M, Liu W. Differentiating brucella spondylitis from tuberculous spondylitis by the conventional MRI and MR T2 mapping: a prospective study. Eur J Med Res 2021; 26:125. [PMID: 34711265 PMCID: PMC8555138 DOI: 10.1186/s40001-021-00598-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background Brucella spondylitis (BS) and tuberculous spondylitis (TS), caused initially by bacteremia, are the two leading types of granulomatous spinal infections. BS is easy to miss or may be misdiagnosed as TS. Our purpose aims to differentiate BS from TS in conventional MR imaging and MR T2 mapping. Methods We performed on 26 BS and 27 TS patients conventional MR imaging and MR T2 mapping. We analyzed the features in conventional MR imaging and measured T2 values of the lesion vertebrae (LV) and unaffected adjacent vertebrae (UAV) in BS and TS patients, respectively. Results There were no significant differences in sex, age, national between BS and TS. There was significantly lower severity of vertebral destruction, vertebral posterior convex deformity, dead bone, and abscess scope in BS when compared to TS (p < 0.001, p = 0.048, p < 0.001, p < 0.001, respectively). The vertebral hyperplasia was significantly higher in BS when compared to TS (p < 0.001). The T2 value of the LV with BS was markedly higher than that in the UAV with BS and that in the LV and UAV with TS (p < 0.001, p < 0.037, p < 0.001, respectively). The T2 value of the LV with TS was significantly higher than that of the UAV in TS and BS (p < 0.001, p < 0.001, respectively). There were no significant differences in the T2 value of the UAV between BS and TS (p = 0.568). Conclusions The qualitative and quantitative evaluation may differentiate BS from TS. The conventional MR imaging helps to distinguish BS from TS by several distinctive features. MR T2 mapping has the additional potential to provide quantitative information between BS and TS.
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Affiliation(s)
- Hui Guo
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Siqin Lan
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Yuanlin He
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Maijudan Tiheiran
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Wenya Liu
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China.
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15
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Alamian S, Etemadi A, Samiee MR, Dadar M. Isolation of Brucella abortus biovar 1 from human lumbar disc bulging: a case report of brucellar discitis. BMC Infect Dis 2021; 21:831. [PMID: 34412583 PMCID: PMC8374416 DOI: 10.1186/s12879-021-06538-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/05/2021] [Indexed: 01/25/2023] Open
Abstract
Background Brucellosis is an endemic zoonotic disease with rising health and economic concerns in many areas worldwide. Musculoskeletal pains are among the main complications of human brucellosis, which are often difficult to diagnose due to the variability of clinical symptoms. Brucellar discitis is a very disabling problem in some chronic forms of the disease which may lead to serious vertebral and neurological consequences. Case presentation In this case report, we reported the isolation of Brucella abortus from lumbar disc bulging in a woman who had rheumatoid arthritis and diabetes mellitus as underlying conditions. The patient had several negative brucellosis serological tests and dorsolumbar pains with urinary incontinence over a 2-month period. The diagnosis was confirmed by magnetic resonance imaging (MRI) examination of lumbar spine as well as disc culture. MRI examination was performed without intravenous contrast and revealed the presence of disc bulging, left foraminal narrowing at L5-S1, left foraminal narrowing, anterolisthesis grade II at L4-L5. The diagnosis was also confirmed by isolation of B. abortus biovar 1 from bulging disc culture. The isolate was characterized by AMOS PCR, Bruce-ladder PCR and biotyping, resulting in the identification of B. abortus from L4-L5 and L5-S1 disc bulging regions. The patient was treated with two drugs i.e. doxycycline and rifampin for 3 months. In the follow-up, in addition to improving the patient’s general condition, low-back pain was also significantly reduced. Conclusions MRI, serology, cultural and molecular test along with patient history are important to make a rapid diagnosis of brucellosis’ discitis, thereby decreasing the delay for the brucellosis treatment. The present report suggests that the infection by Brucella spp. should be fundamentally considered among the causative agents of back pain especially in the endemic areas of Brucella infections.
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Affiliation(s)
- Saeed Alamian
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Afshar Etemadi
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | | | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran.
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16
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Wen H, Jin D, Cai L, Wu T, Liu H. Neurobrucellosis with ischemic stroke and spinal cord involvement: a case report. BMC Neurol 2021; 21:129. [PMID: 33743640 PMCID: PMC7980546 DOI: 10.1186/s12883-021-02155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/11/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Brucellosis is a common zoonotic disease that may have a variety of clinical manifestations when it affects the nervous system. Ischemic stroke is a rare clinical symptom, but if it is not diagnosed and treated early, it may cause more severe consequences. CASE PRESENTATION We report a 38-year-old man presenting with hearing impairment for four years and sudden weakness of the right limb for two years, recurrent aphasia, and gradual weakness of bilateral lower limbs for nine months. He had bilateral positive Babinski's sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed ischemic infarcts in the pons and extensive enhancement of spinal meninges combined with spinal cord atrophy and ischemia. The tests revealed Brucella Rose Bengal positive in serum and CSF. Brucella culture in CSF was also positive. Next-generation sequencing (NGS) of CSF revealed positive for Brucella with 105 species were detected. He showed significant improvement with antibiotics at five months follow-up. CONCLUSIONS Neurobrucellosis may mimic stroke and transverse myelitis like syndromes. NB is a treatable infectious condition and should always be considered in the differentials, especially if there are risk factors, as in our case.
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Affiliation(s)
- Hongfeng Wen
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China
| | - Di Jin
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China
| | - Lina Cai
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China
| | - Tao Wu
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China
| | - Haichao Liu
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China.
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17
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Hu X, Shang X, Wang L, Fan J, Wang Y, Lv J, Nazierhan S, Wang H, Wang J, Ma X. The role of CXCR3 and its ligands expression in Brucellar spondylitis. BMC Immunol 2020; 21:59. [PMID: 33208100 PMCID: PMC7672857 DOI: 10.1186/s12865-020-00390-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/08/2020] [Indexed: 01/18/2023] Open
Abstract
Aim Brucellar spondylitis (BS) is one of the most serious complications of brucellosis. CXCR3 is closely related to the severity of disease infection. This research aimed to study the degree of BS inflammatory damage through analyzing the expression levels of CXCR3 and its ligands (CXCL9 and CXCL10) in patients with BS. Methods A total of 29 BS patients and 15 healthy controls were enrolled. Real-Time PCR was used to detect the mRNA expression levels of IFN-γ, CXCR3, CXCL9 and CXCL10 in peripheral blood mononuclear cells (PBMCs) of BS patients and healthy controls. Hematoxylin-Eosin staining was used to show the pathological changes in BS lesion tissues. Immunohistochemistry staining was used to show the protein expression levels of Brucella-Ab, IFN-γ, CXCR3, CXCL9 and CXCL10 in BS lesion tissues. At the same time, ELISA was used to detect the serum levels of IFN-γ, CXCL9 CXCL10 and autoantibodies against CXCR3 in patients with BS. Results In lesion tissue of BS patients, it showed necrosis of cartilage, acute or chronic inflammatory infiltration. Brucella-Ab protein was abundantly expressed in close lesion tissue. And the protein expression levels of IFN-γ, CXCR3 and CXCL10 were highly expressed in close lesion tissue and serum of BS patients. At the same time, the mRNA expression levels of IFN-γ, CXCR3 and CXCL10 in PBMCs of BS patients were significantly higher than those in controls. Conclusion In our research, the expression levels of IFN-γ, CXCR3 and its ligands were significantly higher than those in controls. It suggested that high expression levels of IFN-γ, CXCR3 and its ligands indicated a serious inflammatory damage in patients with BS.
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Affiliation(s)
- Xin Hu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China.,First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China
| | - Xiaoqian Shang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China.,First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China
| | - Liang Wang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China.,First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China
| | - Jiahui Fan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China
| | - Yue Wang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China
| | - Jie Lv
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China
| | - Shaxika Nazierhan
- Department of Spinal Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830011, P.R. China
| | - Hao Wang
- Department of Spinal Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830011, P.R. China
| | - Jing Wang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China. .,First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China.
| | - Xiumin Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China. .,First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, P.R. China.
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18
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Zhao R, Ding R, Zhang Q. Safety and efficacy of polyetheretherketone (PEEK) cages in combination with one-stage posterior debridement and instrumentation in Lumbar Brucella Spondylitis. Clin Neurol Neurosurg 2020; 199:106259. [PMID: 33031986 DOI: 10.1016/j.clineuro.2020.106259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/06/2020] [Accepted: 09/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to explore the efficacy and safety of surgical treatment of lumbar brucella spondylitis with PEEK cages combined with one-stage posterior debridement and instrumentation. METHODS We performed a retrospective study for adult patients with lumbar brucella spondylitis. Medical records, imaging studies and laboratory data were collected, back pain was measured by employing the visual analog scale (VAS) and the neurological status was evaluated by using the American Spinal Injury Association (ASIA) scale. RESULTS A total of 61 consecutive patients (42 males and 19 females) were enrolled with the mean age at presentation of 56.33 ± 9.16 years old. L3-4 and L4-5 were the most infected levels with the ratios of 21.31 % and 19.67 % respectively. Moreover, 12 (19.67 %) patients suffered multiple-level infection and 5 (5/12, 41.67 %) of them had non-contiguous spondylitis. In addition, epidural masses were found in 26 (42.62 %) cases and psoas abscesses were found in 14 (22.95 %) cases. The number of operative segment depended on operation indications (failure of conservative measures, instability, kyphosis, intractable pain and/or neurological impairment). VAS scores were significantly improved at 6-weeks and the last follow-up. Among the 23 (37.70 %) patients with neurological deficits, 19 (19/23, 82.61 %) obtained a full recovery and 4 (4/23, 17.39 %) had been improved incompletely during the last follow-up. All patients exhibited satisfactory bone fusion during the last follow-up. Local infection of surgical site was identified in 6 (9.84 %) cases and no other surgery-related complications were found. CONCLUSION Use of PEEK cages for interbody fusion is feasible and safe in patients suffering from lumbar brucella spondylitis.
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Affiliation(s)
- Rugang Zhao
- Department of Orthopedic, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China; Beijing Key Laboratory of Emerging Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Rui Ding
- Center of Liver Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Qiang Zhang
- Department of Orthopedic, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
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19
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Fan Z, Yang Y, Li D, Fei Q. A rare lumbar pyogenic spondylodiscitis caused by staphylococcus caprae with initial misdiagnosis: case report and literature review. BMC Surg 2020; 20:200. [PMID: 32928168 PMCID: PMC7491161 DOI: 10.1186/s12893-020-00860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Staphylococcus caprae (Sc) is an uncommon causative organism for human. Lumbar pyogenic spondylodiscitis (LPS) of Sc is extremely rare and only a few cases have been reported. As far as we know, there is no specific literature on the diagnosis and treatment for LPS of Sc with L5 nerve root irritation. Case presentation A 65-year-old male patient complained of chronic low back pain for 10 years, acute worsening with radiating pain to left lower extremity over a month. Physical examination revealed tenderness point on his low back, 3/5 dorsiflexor strength in his left 1st toe and decreased sensation of pin prick over the left lateral shank and medial dorsal foot. The individual was initially misdiagnosed with lumbar disc herniation (LDH) without further examination in outpatient, which was then found to be LPS of Sc with L5 nerve root irritation after admission to our hospital. Magnetic resonance images (MRI) of lumbar spine exhibited inflammation signal at L4-L5 level of the vertebral body and disc with hypointense on T1-weighted images (T1-WI) and hyperintense on T2-weighted images (T2-WI). The causative organism was confirmed by the culture of irrigation fluid obtained from L5 vertebrae by needle puncture. After systemic conservative treatment including using sensitive antimicrobial agents and immobilization, the rare infection was finally cured. The patient also showed a satisfactory recovery during the 36-month follow-up period. Conclusions Confirming the diagnosis and identifying the causative organism as soon as possible is the key point for the treatment of LPS. LPS of Sc causing nerve root irritation is rare but curable with early diagnosis and proper therapy. The culture of irrigation fluid obtained from vertebrae by needle puncture may be an effective and sensitive attempt for potential infection of spine to identify the causative organism at early stage of the disease.
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Affiliation(s)
- Zihan Fan
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Dong Li
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
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20
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Toyne JM, Esplin N, Buikstra JE. Examining variation in skeletal tuberculosis in a late pre-contact population from the eastern mountains of Peru. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 30:22-34. [PMID: 32416540 DOI: 10.1016/j.ijpp.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE AND MATERIALS This research evaluates the presence and chronology of tuberculosis (TB) in the northeastern highlands of Peru (CE 800-1535) through the analysis of osseous lesions from Pre-Contact Kuelap, Chachapoyas. METHODS We examined macroscopic lesion morphology and distribution from the skeletal series (MNI = 207). RESULTS We determined that skeletal evidence was highly consistent with advanced multifocal and spinal tuberculosis in 13 individuals. Destructive lesions of the lower thoracic and/or lumbar vertebra bodies and sacroiliac joints are evident in most cases, but we also observed lesions within the manubriosternal, hip, and knee joints. Both adult males (n = 7) and females (n = 6) present skeletal lesions from young adult to older adults, but there is only one late adolescent. Only three individuals demonstrate similar lesion distributions. CONCLUSIONS Variation in lesion distribution in this population-based study shows the importance of identifying extra-vertebral tuberculosis and suggests that the disease may have manifested differently than at other coastal sites. These cases confirm the presence of tuberculosis both before and after Inca occupation across this central Andean highlands region. SIGNIFICANCE This evidence for the likely endemic presence of TB in the New World prior to European Contact furthers our understanding of the distribution of this infectious disease across the region as well as elucidating lesion distribution. LIMITATIONS The diagnosis of tuberculosis is based on skeletal lesions and it should be confirmed by molecular analysis. FUTURE RESEARCH Additional examination of vertebral bodies (including juvenile remains) for evidence of earlier manifestations of infection.
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Affiliation(s)
- J Marla Toyne
- Department of Anthropology, University of Central Florida, Orlando, FL 32803-1361, United States.
| | - Nathan Esplin
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Jane E Buikstra
- School of Human Evolution and Social Change, Arizona State University, Phoenix metropolitan area, AZ, United States
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21
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Three Cases of Brucellar Spondylitis with Noncontiguous Multifocal Involvement. World Neurosurg 2020; 139:608-613. [DOI: 10.1016/j.wneu.2020.03.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 01/20/2023]
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Brucellar Spondylitis in Kermanshah as an Endemic Area in West of Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.93707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Abstract
Infectious diseases are an important cause of spinal cord dysfunction. Infectious myelopathies are of growing concern given increasing global travel and migration and expanding prevention and treatment with vaccinations, antibiotics, and antiretrovirals. Clinicians must recognize these pathologies because outcomes can dramatically improve with prompt diagnosis and management. We provide a complete review of the most frequent infectious agents that can affect the spinal cord. For each pathogen we describe epidemiology, pathophysiology, anatomic location, characteristic clinical syndromes, diagnostic approach, treatment, and prognosis. The review includes spinal imaging from selected cases.
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Affiliation(s)
- Mayra Montalvo
- Department of Neurology, Brown University, Rhode Island Hospital, 222 Richmond Street, Providence, RI 02903, USA
| | - Tracey A Cho
- Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242, USA.
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24
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Liang C, Wei W, Liang X, De E, Zheng B. Spinal brucellosis in Hulunbuir, China, 2011-2016. Infect Drug Resist 2019; 12:1565-1571. [PMID: 31239732 PMCID: PMC6559255 DOI: 10.2147/idr.s202440] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose: To investigate the demographic, epidemiological, clinical, and laboratory characteristics; treatment options; and outcome of human brucellosis with spine involvement at a major hospital in Hulunbuir, a brucellosis epidemic region of China. Patients and methods: A total of 842 patients with human brucellosis treated in the Department of Brucellosis, Hulunbuir People's Hospital from January 2011 to December 2016 were included and analyzed in this study. The results of 67 brucellar spondylodiscitis (BS) cases were compared with those that were negative for spine involvements. Results: The mean age of spinal brucellosis patients was 50.5±10.2 years (43 males and 24 females; age range 29-70). The risk factors for transmission are direct contact with animals, such as working in the farm, and consumption of unpasteurized milk or daily products. Back pain (92.5%), fever (85.1%), sweating (62.7%), and fatigue (52.8%) were the most common symptoms. Magnetic resonance imaging (MRI) was performed in all the patients with spondylodiscitis. The sites of involvement were lumbar (81.2%), thoracic (8.7%), cervical (4.3%), thoracolumbar (2.9%), and lumbosacral (2.9%). All isolates from blood culture were identified as Brucella melitensis, with 61% biovar 3 and 39% biovar 1 isolates. The antimicrobial therapy for BS lasted for at least 3 months. In the presence of paravertebral or epidural abscess, longer treatment was conducted to avoid possible sequelae. Conclusion: In endemic areas such as Hulunbuir, BS should be considered in patients with back pain and fever. MRI is a highly sensitive imaging modality that can be used to differentiate BS from other spinal infections. This study will be helpful to establish strategies for prevention, surveillance, and management of spinal brucellosis in China.
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Affiliation(s)
- Chen Liang
- Department of Brucellosis, Hulunbuir People's Hospital, Hulunbuir, People's Republic of China.,School of Medicine, Inner Mongolia University for Nationalities, Hulunbuir, People's Republic of China
| | - Wei Wei
- Hulunbuir Center for Disease Control and Prevention, Hulunbuir, People's Republic of China
| | - Xiuwen Liang
- Department of Brucellosis, Hulunbuir People's Hospital, Hulunbuir, People's Republic of China.,School of Medicine, Inner Mongolia University for Nationalities, Hulunbuir, People's Republic of China
| | - Enjin De
- Department of Brucellosis, Hulunbuir People's Hospital, Hulunbuir, People's Republic of China.,School of Medicine, Inner Mongolia University for Nationalities, Hulunbuir, People's Republic of China
| | - Beiwen Zheng
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Zhang Y, Zhang Q, Zeng Z. Histopathological findings of nucleus pulposus in lumbar brucellar spondylodiscitis. Rev Soc Bras Med Trop 2019; 52:e20180108. [PMID: 30994792 DOI: 10.1590/0037-8682-0108-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/18/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yao Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zheng Zeng
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Liu X, Li H, Jin C, Niu G, Guo B, Chen Y, Yang J. Differentiation Between Brucellar and Tuberculous Spondylodiscitis in the Acute and Subacute Stages by MRI: A Retrospective Observational Study. Acad Radiol 2018; 25:1183-1189. [PMID: 29609954 DOI: 10.1016/j.acra.2018.01.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/24/2018] [Accepted: 01/28/2018] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to reveal the distinctive features of magnetic resonance imaging (MRI) for distinguishing brucellar spondylodiscitis (BSD) from tuberculous spondylodiscitis (TSD) in the acute and subacute stages. METHODS This study involved 14 patients with BSD and 18 patients with TSD from May 2011 to January 2015. BSD was diagnosed based on ≥1/160 titers of a Brucella agglutination test or isolation of Brucella spp. TSD was diagnosed based on the isolation of tuberculosis bacteria. All patients underwent T1- and T2-weight imaging (T1WI and T2WI) and fat suppression T2WI (FS T2WI). The height and the signal intensity (SI) of the vertebra and intervertebral disc were assessed. The distinctive MRI features were compared using the chi-square test. The SI of the vertebra between BSD and TSD was observed in terms of histogram characteristics of kurtosis, skewness, and percentile (75%-25%) on FS T2WI. RESULTS Twenty-nine (76.3%) vertebrae of BSD were infected throughout the whole vertebra, and 49 (90.7%) vertebrae of TSD were infected near the osseous end plate (P <.001). Compared to TSD, the vertebral height of BSD was nearly intact (P <.001), owing to the new bone formation in the end plate without vertebral collapse. Furthermore, significant differences in the SI of the vertebra were observed between patients with BSD and TSD in terms of homogeneous characteristics on FS T2WI, that is, kurtosis (BSD vs TSD, 0.107 vs -0.250, P = .023), skewness (BSD vs TSD, -0.021 vs 0.266, P = .017), and percentile (75%-25%) (BSD vs TSD, 54.498 vs 79.399, P = .00049). CONCLUSIONS The nearly intact vertebra with homogeneous high signal on FS T2WI was an important MRI feature for distinguishing BSD from TSD in the acute and subacute stages.
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Affiliation(s)
- Xinxin Liu
- Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Department of Magnetic Resonance Imaging, Hong Hui Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Hua Li
- Department of Magnetic Resonance Imaging, Second Hospital of Yulin City, Yulin, Shaanxi Province, China
| | - Chao Jin
- Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Gang Niu
- Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| | - Baoqin Guo
- Department of Magnetic Resonance Imaging, Second Hospital of Yulin City, Yulin, Shaanxi Province, China
| | - Yi Chen
- Department of Magnetic Resonance Imaging, Second Hospital of Yulin City, Yulin, Shaanxi Province, China
| | - Jian Yang
- Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
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Li T, Li W, Du Y, Gao M, Liu X, Wang G, Cui H, Jiang Z, Cui X, Sun J. Discrimination of pyogenic spondylitis from brucellar spondylitis on MRI. Medicine (Baltimore) 2018; 97:e11195. [PMID: 29952971 PMCID: PMC6039692 DOI: 10.1097/md.0000000000011195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Retrospective Cross-Sectional Study.The purpose of this study was to investigate the accuracy of magnetic resonance imaging (MRI) for distinguishing between pyogenic spondylitis and brucellar spondylitis.Although pyogenic spondylodiscitis (PS) and brucellar spondylitis (BS) are common causes of spinal infections, the variety of their clinical manifestations complicates differential diagnosis. MRI may be helpful in differential diagnosis and treatment.MRI images of 64 patients who underwent MRI of the spine and with confirmed spondylitis were retrospectively reviewed. After referring to the related medical literature, we compared 32 patients with pyogenic spondylitis and 32 patients with brucellar spondylitis regarding MRI findings. Statistical analysis was performed with the chi-square test. Statistical significance was defined as P < .05.The significant differences between PS and BS on MRI findings are listed as follows (P < .05): diffuse, partial and fan-shaped hyperintense signals on middle sagittal fat-suppressed weighted images (PS: 51, 11, 3/65 vs BS:35, 18, 19/72); focal endplate destruction (PS: 9/43 vs BS:27/35); extensive end plate destruction (PS: 29/43 vs BS:8/35); ballooning change of the intravertebral space (PS: 7/32 vs BS:0/32); an inflammatory reaction line from the end plate (PS: 30/65 vs BS: 1/72); a disc invasion sign (PS: 1/28 vs BS:12/33); an inflammatory reaction line in the disc (PS: 5/28 vs BS:25/33); and 8) severe intravertebral space destruction (PS: 17/28 vs BS:12/33);MRI imaging provides useful information for the differentiation between pyogenic spondylitis and brucellar spondylitis.
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Affiliation(s)
- Tao Li
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Wei Li
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yong Du
- Department of Orthopedics, Qingyun County People's Hospital, Jinan City, PR China
| | - Meng Gao
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Xiaoyang Liu
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Guodong Wang
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Haomin Cui
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Zhensong Jiang
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Xingang Cui
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Jianmin Sun
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
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Tu L, Liu X, Gu W, Wang Z, Zhang E, Kahar A, Chu G, Zhao J. Imaging-Assisted Diagnosis and Characteristics of Suspected Spinal Brucellosis: A Retrospective Study of 72 Cases. Med Sci Monit 2018; 24:2647-2654. [PMID: 29705812 PMCID: PMC5946739 DOI: 10.12659/msm.909288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background We clarified the imaging features of Brucella spondylitis to enhance our understanding of the disease and to minimize misdiagnosis. Material/Methods Imaging data (X-ray, computed tomography [CT], and magnetic resonance imaging [MRI] data) of 72 Brucella spondylitis patients treated from 2010 to 2017 were retrospectively analyzed; diagnoses was made by evaluating laboratory and pathological data. Results X-ray films revealed changes in intervertebral space heights, the number of lateral osteophytes, and bone destruction, which were more severe in the following order: lumbosacral vertebrae (56 cases, 77.8%), cervical spine (6 cases, 8.3%), thoracic spine (5 cases, 6.9%), and multi-segmental mixed vertebrae (5 cases, 6.9%). CT revealed osteolytic destruction attributable to early-stage Brucella spondylitis (endplate and vertebral lamellar osteolysis), usually associated with multiple vertebral involvement, with the middle and late disease stages being characterized by osteophytes in the vertebral margins and bony bridges, endplate sclerosis, and vertebral osteosynthesis. We encountered 54 cases (75%) with endplate lamellar osteolysis, 37 (51.4%) with vertebral lamellar osteolysis, 59 (81.9%) with marginal osteophytes, 10 (13.9%) with bony bridges, 25 (34.7%) with vertebral laminar sclerosis, and 17 (23.6%) with vertebral osteosynthesis. MRI revealed early, low-intensity, differential T1WI vertebral and intervertebral signals, with occasional iso-signals, T2WI iso-signals or high-intensity signals; and T2WI-FS vertebral and intervertebral high-intensity signals, commonly from vertebral soft tissues and rarely from paravertebral abscesses. Conclusions A better understanding of the X-ray, CT, and MRI features of Brucella spondylitis could aid in diagnosis when combined with epidemiological and laboratory data, thus minimizing misdiagnosis.
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Affiliation(s)
- Laiyong Tu
- Department of Spinal Surgery, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China (mainland)
| | - Xinmei Liu
- Department of Spinal Surgery, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China (mainland)
| | - Wenfei Gu
- Department of Spinal Surgery, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China (mainland)
| | - Zhenbin Wang
- Department of Spinal Surgery, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China (mainland)
| | - Enfeng Zhang
- Department of Spinal Surgery, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China (mainland)
| | - Aikenmu Kahar
- Department of Spinal Surgery, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China (mainland)
| | - Ge Chu
- Department of Spinal Surgery, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China (mainland)
| | - Jiang Zhao
- Department of Spinal Surgery, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China (mainland)
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Qiao P, Zhao P, Gao Y, Bai Y, Niu G. Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis. Chin J Cancer Res 2018; 30:425-431. [PMID: 30210222 PMCID: PMC6129564 DOI: 10.21147/j.issn.1000-9604.2018.04.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis were quantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess the value of DCE-MRI in the differential diagnosis of these diseases. Methods Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor (30 cases of each) received conventional MRI and DCE-MRI examination. The volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve) and plasma volume fraction (Vp) of the diseased vertebral bodies were measured on the perfusion parameter map, and the differences in these parameters between the patients were compared.
Results For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis, respectively, the Ktrans values (median ± quartile pitch) were 0.989±0.014, 0.720±0.011 and 0.317±0.005 min–1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min–1; the Ve values were 0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; the corresponding H values were 50.25 (for Ktrans), 52.47 (for Kep), 48.33 (for Ve) and 46.56 (for Vp), and all differences were statistically significant (two-sided P<0.05).
Conclusions The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis.
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Affiliation(s)
- Pengfei Qiao
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Pengfei Zhao
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yang Gao
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yuzhen Bai
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Guangming Niu
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
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Shen L, Jiang C, Jiang R, Fang W, Feng Q, Wang L, Wu C, Ma Z. Diagnosis and classification in MRI of brucellar spondylitis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jrid.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Gündüz T, Tektürk PT, Yapıcı Z, Kürtüncü M, Somer A, Törün SH, Eraksoy M. Characteristics of isolated spinal cord involvement in neurobrucellosis with no corresponding MRI activity: A case report and review of the literature. J Neurol Sci 2016; 372:305-306. [PMID: 28017234 DOI: 10.1016/j.jns.2016.11.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Tuncay Gündüz
- Department of Neurology and Child Neurology, Istanbul Faculty of Medicine, Istanbul University, Fatih/Capa, 34093 Istanbul, Turkey.
| | - Pınar Topaloğlu Tektürk
- Department of Neurology and Child Neurology, Istanbul Faculty of Medicine, Istanbul University, Fatih/Capa, 34093 Istanbul, Turkey.
| | - Zuhal Yapıcı
- Department of Neurology and Child Neurology, Istanbul Faculty of Medicine, Istanbul University, Fatih/Capa, 34093 Istanbul, Turkey.
| | - Murat Kürtüncü
- Department of Neurology and Child Neurology, Istanbul Faculty of Medicine, Istanbul University, Fatih/Capa, 34093 Istanbul, Turkey.
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Istanbul Faculty of Medicine, Istanbul University, Fatih/Capa, 34093 Istanbul, Turkey.
| | - Selda Hançerli Törün
- Department of Pediatric Infectious Diseases, Istanbul Faculty of Medicine, Istanbul University, Fatih/Capa, 34093 Istanbul, Turkey
| | - Mefkure Eraksoy
- Department of Neurology and Child Neurology, Istanbul Faculty of Medicine, Istanbul University, Fatih/Capa, 34093 Istanbul, Turkey.
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