Safety and efficacy of polyetheretherketone (PEEK) cages in combination with one-stage posterior debridement and instrumentation in Lumbar Brucella Spondylitis

doi:10.1016/j.clineuro.2020.106259

Clinical Neurology and Neurosurgery

Volume 199, December 2020, 106259

https://doi.org/10.1016/j.clineuro.2020.106259 Get rights and content

Highlights

•
AS a last management option, diagnostic or curative surgery can be performed in brucella spondylitis.
•
The use of PEEK cage in the surgical treatment of brucella spondylitis is rarely reported.
•
We analyze the largest cohort of patients with lumbar brucella spondylitis receiving PEEK cages implantation.

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.

Introduction

Humans would infect brucellosis through the contact with infected animals and the consumption of unpasteurized milk or cheese. It is shown by previous studies that a total of over 500,000 new cases of brucellosis would occur every year around the world [1]. Although brucellosis has been controlled very well in developed countries with the socio-economic development and improvement of regulatory system, it is still a serious public health problem in developing countries [1]. In China, the incidence rate of human brucellosis presents progressively elevation year by year since 1990 [2]. From 2004–2018, a total of about 4,490,000 patients were diagnosed as brucellosis with an average annual incidence rate of 0.0259 per 100,000 population [3]. Brucellosis has been identified as a systemic infectious disease that presents a variety of atypical clinical manifestations including arthralgia, fever, weakness, and low back pain [4].Spine brucellosis is viewed as the most common bony infection with the incidence rate of 2−53%, and the lumbar spine is the most encountered [5].

Over the past years, as far as brucella spondylitis is concerned, conservative treatment is deemed as the main therapeutic strategy, and a considerable amount of patients have obtained satisfactory outcome through the application of antibiotics [6]. However, the conservative approach may lead to terrible long-term problems such as recurrence, residual low back pain, and late-onset paralysis [7]. Then, diagnostic or curative surgery, which is deemed as a last management option, can be performed in brucella spondylitis [8].

Because the advantages of polyetheretherketone (PEEK) cage over titanium mesh have been observed for the radioparency and biomechanical behavior, more and more studies reported the best use of PEEK cage in pyogenic spinal infection and spinal tuberculosis [9]. However, the use of PEEK cage in the surgical treatment of brucella spondylitis is rarely reported.

Herein, we analyze the clinicopathological character of the largest cohort of patients with lumbar brucella spondylitis receiving PEEK cages implantation to evaluate the safety and effectiveness of PEEK cage usage in lumbar brucella spondylitis.

Section snippets

Study participates

A total number of 61 adult consecutive patients (42 males and 19 females) with lumbar brucella spondylitis and had received surgery of one-stage posterior debridement, instrumentation, and interbody fusion with PEEK cages from January 2015 to January 2019 in our institution were recruited in this study (Fig. 1). Clinical information was obtained from medical records and imaging, which included gender, age, Magnetic Resonance Imaging (MRI), Computed Tomography (CT), etc. All the procedures

Clinical characters

Of the 61 cases (42 males and 19 females), the mean age was 56.33 ± 9.16 years old (range, 28–73 yeas). The summary of clinical symptoms is displayed in Table 1. A titer >1:160 on the brucellosis standard tube agglutination test was detected in the entire cases and blood culture positive for Brucella was found in only in 7 (11.48 %) cases. The lumbar spine infection is listed in Table 1. As shown in Table 1, L3−4 and L4−5 levels were most commonly involved with ratios of 21.31 % and 19.67 %

Discussion

Brucella spondylitis which is one of the most encountered complication of brucellosis (2−53%), was initially described by Kulowski and Vinke in 1932 [10,11]. 24(39.34) patients in this study were 50−60 years. It is noticeable that 21 (34.43 %) patients in our study were older than 60 years, of which 5 (8.20 %) patients were older than 70 years.

In current study, back pain (100 %), which was followed by high fever (88.52%) and sweating (81.97%), was deemed as the most common symptom. The

Funding

No.

Ethical approval

This retrospective study was approved by the ethics committee of Beijing Ditan Hospital, Capital Medical University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the insti- tutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

Informed consent

Informed consent was obtained from all individual participants included in the study.

CRediT authorship contribution statement

Rugang Zhao: Data curation, Writing - original draft, Software, Validation. Rui Ding: Data curation, Writing - original draft, Investigation. Qiang Zhang: Conceptualization, Methodology, Supervision, Writing - review & editing.

Declaration of Competing Interest

The authors declare no conflict of interests.

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MRI-based interpretable radiomics nomogram for discrimination between Brucella spondylitis and Pyogenic spondylitis
2024, Heliyon
Pyogenic spondylitis (PS) and Brucella spondylitis (BS) are commonly seen spinal infectious diseases. Both types can lead to vertebral destruction, kyphosis, and long-term neurological deficits if not promptly diagnosed and treated. Therefore, accurately diagnosis is crucial for personalized therapy. Distinguishing between PS and BS in everyday clinical settings is challenging due to the similarity of their clinical symptoms and imaging features. Hence, this study aims to evaluate the effectiveness of a radiomics nomogram using magnetic resonance imaging (MRI) to accurately differentiate between the two types of spondylitis.
Clinical and MRI data from 133 patients (2017–2022) with pathologically confirmed PS and BS (68 and 65 patients, respectively) were collected. We have divided patients into training and testing cohorts. In order to develop a clinical diagnostic model, logistic regression was utilized to fit a conventional clinical model (M1). Radiomics features were extracted from sagittal fat-suppressed T2-weighted imaging (FS-T2WI) sequence. The radiomics features were preprocessed, including scaling using Z-score and undergoing univariate analysis to eliminate redundant features. Furthermore, the Least Absolute Shrinkage and Selection Operator (LASSO) was employed to develop a radiomics score (M2). A composite model (M3) was created by combining M1 and M2. Subsequently, calibration and decision curves were generated to evaluate the nomogram's performance in both training and testing groups. The diagnostic performance of each model and the indication was assessed using the receiver operating curve (ROC) with its area under the curve (AUC). Finally, we used the SHapley Additive exPlanations (SHAP) model explanations technique to interpret the model result.
We have finally selected 9 significant features from sagittal FS-T2WI sequences. In the differential diagnosis of PS and BS, the AUC values of M1, M2, and M3 in the testing set were 0.795, 0.859, and 0.868. The composite model exhibited a high degree of concurrence with the ideal outcomes, as evidenced by the calibration curves. The nomogram's possible clinical application values were indicated by the decision curve analysis. By using SHAP values to represent prediction outcomes, our model’s prediction results are more understandable.
The implementation of a nomogram that integrates MRI and clinical data has the potential to significantly enhance the accuracy of discriminating between PS and BS within clinical settings.
Comparison of two surgical interventions for lumbar brucella spondylitis in adults: a retrospective analysis
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¹: These authors contributed equally to this work.

View full text

Safety and efficacy of polyetheretherketone (PEEK) cages in combination with one-stage posterior debridement and instrumentation in Lumbar Brucella Spondylitis

Highlights

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Study participates

Clinical characters

Discussion

Funding

Ethical approval

Informed consent

CRediT authorship contribution statement

Declaration of Competing Interest

Lancet Infect. Dis.

Neuroimaging Clin. N. Am.

Spine J.

Clin. Imaging

Human brucellosis in the People’s Republic of China during 2005-2010

Int. J. Infect. Dis.

Temporal trends analysis of human brucellosis incidence in mainland China from 2004 to 2018

Sci. Rep.

Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature

Int. J. Infect. Dis.

Spinal brucellosis: turkish experience based on 452 cases published during the last century

Acta Neurochir. (Wien)

[Brucellar spondylodiscitis: case series of the last 25 years]

Acta Med. Port.

Update on treatment options for spinal brucellosis

Clin. Microbiol. Infect.

Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis

BMC Surg.

Safety and efficacy of polyetheretherketone (PEEK) cages in combination with posterior pedicel screw fixation in pyogenic spinal infection

Acta Neurochir. (Wien)

Brucellar spondylitis: review of 35 cases and literature survey

Clin. Infect. Dis.