Establishment and Clinical Application of One-stage Posterior Limited Lesion Clearanceand Internal Fixation Combined With Personalized Drug Therapy System for Brucellosis Spondylitis
Author(s): Xinming Yang, Ye Tian, Yao Yao
To investigate the feasibility and clinical effect of one-stage posterior limited lesion clearance and internal fixation combined with individualized drugs in the treatment of brucidosis spondylitis.
44 patients who conform to inclusion criteria, including 2 cases thoracolumbar segment, 32 cases lumbar segment and 10 cases lumbosacral segment. Preoperative VAS(Visua Analogue Scales) 5~8,ODI(Oswestry disability index) 51.15~84.36%, Body Mass Index (BMI) 16.2~17.5, American Spinal Injury Association (ASIA) classification C grade 6 and D grade 10. Magnetic Resonance Imaging (MRI) showed compression of dural sac in 16 cases. Preoperative medication regimen was developed according to the patient's medication allergy history, weight, liver and kidney function, and T-lymphocyte spot test (T-SOPT).
Postoperative individualized medication was used according to the drug sensitivity test and T-SOPT to select 3 kinds of sensitive drugs for 2 courses of treatment, and the patients were clinically cured 3 to 9 months. The evaluation indexes of Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Rose Bengal Plate agglutination Test(RBPT), VAS,BMI,ASIA,ODI and MRI at each time point were significantly improved compared with those before surgery (P<0.05). Follow-up showed that the lesions were completely cleared, inflammation was absorbed, pedicle screw fixation was good, spine stable, intervertebral bone grafting was fused, and the spinal cord were well aligned without compression.
Personalized medication is highly targeted, conforms to pharmacokinetics, has low toxic and side effects, no drug allergy or drug resistance, so as to reduce medical expenses and obtain the maximum clinical efficacy with the minimum cost. One-stage posterior limited lesion clearance and internal fixation surgery has little trauma, and the lesions are completely removed. The correct choice of screw placement and short segment internal fixation of diseased vertebra is safe and reliable.