Name: diagnosis and surgical treatment of human brucellar spondylodiscitis
Uploaded: 2021-05-23T12:30:00
Description: Watch this Scientific Journal Video about Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis at JoVE.com

Dr. Xiaoyu Cai acknowledges the financial support from the China Scholarship Council. This work was funded by the Natural Science Foundation of Xinjiang Province, P. R. China (no. 2016B03047-3).

The study was approved by the ethical committee of the First Affiliated Hospital of Xinjiang Medical University, China17.
1. Informed Consent
<ol>
	<li>Obtain the patient&#39;s informed consent after explaining the details of the surgical procedure, postoperative prognosis, and possible complications (infection, epidural hematoma, spinal cord injury, failure of internal fixation, and cerebrospinal fluid leakage).</li>
	<li>Explain the other risks generally associated ...

The present guideline of diagnosis and surgical treatment of human BS with a detailed protocol and satisfactory clinical evidence from representative cohorts shows clinical efficacy and is proposed for large-scale application to manage human BS, especially in endemic regions. The first critical step in the treatment of BS is to make the correct diagnosis. The diagnosis of BS needs to be differentiated from spinal tuberculosis compared to which BS is relatively less bone-destructive and usually responds effectively to ant...

With more than half a million new cases annually, human Brucellosis has become a public health concern and remains an enormous burden worldwide1,2,3,4. BS, as the most common and severe osteoarticular manifestation of human Brucellosis, involves multiple structures including vertebral bodies, intervertebral disc, and paraspinal structures5,6. It occurs frequently in the lumbosacral zone and needs to be differentiated from other infectious diseases because of its nonspecific clinical characteristics7,8. Despite the significant advances in research over the past decades, accurate and timely diagnosis of BS is still a challenge for clinicians due to its late-onset radiological findings, slow growth rate in blood cultures, and the complexity of its serodiagnosis9. Therefore, human BS remains clinically underdiagnosed and underreported. Although the past decades have seen increasingly rapid advances in the introduction and popularization of several therapeutic guidelines, there is still no consensus for an optimal management modality10. Frequent relapses, treatment failure, and sequelae are reported constantly11.
Of note, BS can be severely debilitating and disabling even if it is rarely fatal. If it is not treated appropriately, possible serious sequelae might be induced including persistent back pain, neurological deficiency, and even kyphotic deformity12,13. Antibiotic therapy is the core in the treatment of BS and yields generally promising outcomes9. However, certain patients may require surgical treatment if neurological dysfunction, spinal instability, abscess formation, intractable pain, or a previous unsatisfactory response to conservative treatments are observed. Surgical intervention remains controversial. Different surgical procedures for debridement and fusion have been described for infectious diseases of the lumbar spine including anterior-only, posterior-only, and combined approaches14,15,16. Here, diagnostic guidelines have been presented for human BS and for the single-stage surgical treatment with transforaminal decompression, debridement, interbody fusion, and internal fixation via a posterior-only approach. A detailed protocol of this method is given below.

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			<td>DePuy Synthes Companies</td>
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			<td>DePuy Synthes Companies</td>
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			<td>Securo Drain</td>
			<td>Dispomedica GmbH</td>
			<td>1.33578</td>
			<td>Size: 7 mm; Length of perforation: 15 cm; Total length: 80 cm; Reservior size: 150 ml</td>
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			<td>Sterile 0.9% Sodium Chloride Solution</td>
			<td>Beijing SanYao Science &#38; Technology Development Co.</td>
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			<td>Streptomycin sulfate, Powder</td>
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diagnosis and surgical treatment of human brucellar spondylodiscitis

Brucellar spondylodiscitis (BS) is the most prevalent and significant osteoarticular presentation of human Brucellosis, which is commonly manifested in pastoral communities. It is difficult to differentially diagnose and usually leads to irreversible neurologic deficits and spinal deformities. The initial diagnosis of BS is based on clinical findings and radiographic assessments, and the confirmed diagnosis should be established by the isolation of Brucella species from the blood and/or the standard tube agglutination test. Differential diagnosis of multifocal BS from either degenerative disc diseases or tuberculosis is especially highlighted. The surgical approach, either endoscopic or open, is demonstrated in detail, accompanied by radiographic evidence of structural compression or severe instability. Further, the crucial surgical steps, including single-stage transforaminal decompression, debridement, interbody fusion, and internal fixation, are explained. Moreover, perioperative care and postoperative rehabilitation are also addressed. Taken together, this clinical algorithm presents a practical guide that has yielded substantially satisfactory outcomes in the past decades, which can also be introduced for large-scale application to manage human BS, especially in endemic regions.

This paper describes a prospective, non-randomized, controlled study of 32 consecutive BS patients who were treated by a single-stage transforaminal decompression, debridement, interbody fusion, and internal fixation via a posterior-only approach in the Department of Spine Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. Figure 1 shows a typical case in this study.
T...

Watch this Scientific Journal Video about Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis at JoVE.com

Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis

We describe a clinical algorithm, based on decades of front-line experience of diagnosis and surgical treatment of human Brucellar spondylodiscitis in the largest medical center of the China's Xinjiang Pastoral Area.

Brucellar spondylodiscitis (BS) is the most prevalent and significant osteoarticular presentation of human Brucellosis, which is commonly manifested in ...

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