Department of Orthopaedics, National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Front Public Health. 2024 May 22;12:1396152. doi: 10.3389/fpubh.2024.1396152. eCollection 2024.
Spondylitis caused by infection is a rare but challenging condition, and its successful management depends on timely diagnosis and appropriate treatment. This study reports two typical cases of thoracic and lumbar brucellosis spondylitis, highlighting the pivotal roles of real-time polymerase chain reaction (real-time PCR) detection and surgical intervention.
Case 1 involved a 49-year-old male shepherd who presented with a 6-month history of fever (40°C), severe chest and back pain, and 2-week limited lower limb movement with night-time exacerbation. Physical examination revealed tenderness and percussion pain over the T9 and T10 spinous processes, with grade 2 muscle strength in the lower limbs. CT showed bone destruction of the T9 and T10 vertebrae with narrowing of the intervertebral space, whereas MRI demonstrated abnormal signals in the T9-T10 vertebrae, a spinal canal abscess, and spinal cord compression. The Rose Bengal plate agglutination test was positive. Case 2 was a 59-year-old man who complained of severe thoracolumbar back pain with fever (39.0°C) and limited walking for 2 months. He had a 2.5 kg weight loss and a history of close contact with sheep. The Rose Bengal test was positive, and the MRI showed inflammatory changes in the L1 and L2 vertebrae. Diagnosis and treatment: real-time PCR confirmed infection in both cases. Preoperative antimicrobial therapy with doxycycline, rifampicin, and ceftazidime-sulbactam was administered for at least 2 weeks. Surgical management involved intervertebral foraminotomy-assisted debridement, decompression, internal fixation, and bone grafting under general anesthesia. Postoperative histopathological examination with HE and Gram staining further substantiated the diagnosis. Outcomes: both patients experienced significant pain relief and restored normal lower limb movement at the last follow-up (4-12 weeks) after the intervention.
Real-time PCR detection offers valuable diagnostic insights for suspected cases of brucellosis spondylitis. Surgical treatment helps in infection control, decompression of the spinal cord, and restoration of stability, constituting a necessary and effective therapeutic approach. Prompt diagnosis and comprehensive management are crucial for favorable outcomes in such cases.
感染引起的脊柱炎是一种罕见但具有挑战性的疾病，其成功管理取决于及时的诊断和适当的治疗。本研究报告了两例典型的胸腰椎布鲁氏菌病脊柱炎病例，强调了实时聚合酶链反应（real-time PCR）检测和手术干预的关键作用。
病例 1 为一名 49 岁男性牧羊人，发热（40°C）6 个月，严重胸痛和背痛，下肢活动受限 2 周，夜间加重。体格检查显示 T9 和 T10 棘突压痛和叩击痛，下肢肌力 2 级。CT 显示 T9 和 T10 椎体骨质破坏，椎间隙变窄，MRI 显示 T9-T10 椎体异常信号、椎管脓肿和脊髓受压。虎红平板凝集试验阳性。病例 2 为 59 岁男性，诉严重胸腰椎背痛伴发热（39.0°C）和步行受限 2 个月。他体重减轻 2.5kg，有与绵羊密切接触史。虎红试验阳性，MRI 显示 L1 和 L2 椎体炎症改变。
实时 PCR 证实两例均为 感染。术前给予多西环素、利福平、头孢他啶-舒巴坦至少 2 周的抗菌治疗。全身麻醉下采用椎间孔切开辅助清创、减压、内固定和植骨进行手术治疗。术后行 HE 和革兰染色组织病理学检查进一步证实诊断。
两例患者术后均出现明显疼痛缓解，下肢运动功能恢复正常，最后一次随访（4-12 周）。
实时 PCR 检测对疑似布鲁氏菌病脊柱炎病例具有重要的诊断价值。手术治疗有助于控制感染、脊髓减压和恢复稳定性，是一种必要且有效的治疗方法。及时诊断和综合管理对于此类病例的良好结局至关重要。
