背景:颈脊髓布鲁氏菌病的发病率很低,只有少数病例报告发表,和病例系列在医学文献中没有广泛报道。因此,临床特征,管理,和颈脊髓布鲁氏菌病的结果相对未知。在这个系列中,作者报告了15例颈脊髓布鲁氏菌病患者,包括临床特征,影像学发现,管理计划,该机构的经验,术后1年的结果。
方法:该研究回顾了15例接受抗菌药物治疗的患者的临床和影像学记录,颈前路清创融合术治疗颈脊髓布鲁氏菌病。收集的数据包括患者的人口统计学特征,脊髓水平受影响,脓肿,神经学,病理报告,抗菌方案的持续时间和类型,骨科管理的细节,以及手术过程中出现的并发症。
结果:颈部疼痛(100%)和肢体麻痹(86.7%)是最常见的临床表现,疾病进展迅速。C6-7段是最常见的影响段,其次是C4-5和C5-6。影像学通常显示硬膜外或椎旁脓肿(80%)。VAS有了很大的改进,JOA,手术后三个月的NDI评分,分数继续提高,直到最后的随访。术前、术后评分差异有统计学意义(P<0.05)。术后3个月ESR和CRP水平恢复正常,为7.7±4.5mm/h和7.55±3.48mg/L,分别。术前、术后水平差异有统计学意义(P<0.05)。脓液或病变组织细菌培养检测阳性率仅为40%,但是血液培养显示出更低的阳性率(33.3%)。抗菌药物治疗方案的平均持续时间为6.1±1.9个月。所有患者在术后8个月(4.8±1.4个月)内实现椎间植骨融合,均治愈,无复发。
结论:脊柱布鲁氏菌病很少影响宫颈区域,但它的影响是更危险的,因为潜在的并发症,如截瘫或四肢瘫痪引起的硬膜外脓肿压迫脊髓。外科清创术,除了必要的抗菌治疗,是一种有效的策略,可以导致满意的预后治疗颈脊髓布鲁氏菌病。
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.