What issues should be understood when treating brucellotic spondylitis surgically?

Author: Zhang Qiang, Chief Physician, Beijing Ditan Hospital, Capital Medical University

Reviewer: Ren Dajiang, Chief Physician of the Seventh Medical Center of the General Hospital of the Chinese People's Liberation Army

For patients with brucellotic spondylitis, if medication is ineffective and symptoms are severe, and imaging shows severe vertebral damage, surgical treatment is often required.

What are the surgical methods for treating brucellosis spondylitis? Will the pain go away after surgery? How long will it take before I can get up and move around? What should I pay attention to in my diet? Why do I feel pain and heaviness in my thighs after surgery? How long will it take to go back to the hospital for a follow-up checkup? How can I prevent recurrence? Let's learn about it together.

1. What are the methods for surgical treatment of brucellotic spondylitis?

Depending on the severity of brucellotic spondylitis lesions, minimally invasive or open surgery can be used. Open surgery is divided into anterior approach, posterior approach, and combined anterior and posterior approach.

At present, for mild cases, minimally invasive treatment methods are generally used, such as perforaminal endoscopic surgery, UBE (unilateral double-channel spinal endoscopic surgery), OLIF (minimally invasive lateral anterior lumbar interbody fusion surgery). For open surgery, most of them are still done through the posterior approach. For patients with some lesions or abscesses in the front, some minimally invasive methods can be used, such as perforaminal endoscopic surgery or other puncture methods, to remove the abscess or lesion tissue in the front at the same time.

2. Will patients with brucellosis spondylitis feel pain-free after surgery? How long will it take for them to be able to walk?

The vast majority of patients experience significant pain relief after surgical treatment. Many patients with severe pain feel little pain soon after surgery and can resume normal life and work.

Therefore, surgery is very effective in treating this type of pain, because it removes the lesions, makes the unstable spine stable, and restores the supporting strength of the spine, so the pain will be relieved immediately, and the effect is very obvious.

After the operation, you should stay in bed for a period of time, generally about a week. After all drainage tubes are removed, you can walk by wearing a spinal brace under the guidance of a doctor.

Figure 1 Original copyright image, no permission to reprint

It is important to remind everyone that when you start walking, you must walk under the protection of a brace. After walking, the patient will be able to recover the walking function quickly, and can walk without support in about two weeks, and can basically return to normal life after three months.

3. What should patients with brucellosis spondylitis pay attention to in terms of diet after surgery? Can they smoke or drink?

Generally speaking, you can eat 4-6 hours after general anesthesia on the same day.

Brucellosis itself is a wasting disease, so after surgery you should fully supplement with foods high in protein. Meat, fish, and some seafood can all be eaten to increase the body's nutrition and immune function.

Smoking and drinking are not good for postoperative recovery. Many studies have shown that smoking can cause vasoconstriction, which may affect wound healing; drinking is definitely not allowed, because drinking can cause some bleeding and increase wound exudate, which is a bad habit.

4. How long does it take for patients with brucellotic spondylitis to return to the hospital for a follow-up checkup after surgery?

This type of follow-up should be similar to routine surgery.

If the stitches have not been removed, come for a checkup in about 2 weeks to have them removed; then take an X-ray and have a checkup in 1 month; in addition, checkups should also be conducted every 6 months and 1 year. Regular follow-up is very important, and anti-brucellosis drugs should be used consistently until the disease is cured.

Figure 2 Original copyright image, no permission to reprint

Now many patients feel better after being discharged from the hospital and do not go to the hospital for follow-up examination. This practice is wrong. Regular follow-up examinations are necessary so that possible complications after surgery can be discovered in time and treated in time.

5. Is brucellotic spondylitis prone to relapse after surgery?

The postoperative recurrence rate is very low, less than 1%.

The factors related to recurrence include the virulence of the bacteria, the body's resistance to the bacteria, and whether we can strictly follow the doctor's instructions to take medication regularly. To prevent recurrence, we need to take medication in sufficient amounts and for a sufficient course of treatment.

For brucellosis spondylitis, the quadruple therapy before surgery is a 2-week course of treatment. Generally, two courses of treatment are required, that is, four weeks of quadruple therapy, including oral doxycycline, rifampicin, and intravenous ofloxacin or third-generation cephalosporin drugs. The inflammatory indicators and bacteria are suppressed before surgery.

After surgery, we need to take another course of treatment, which is a 2-week quadruple medication. If the inflammatory indicators are basically under control, we will switch to an oral dual medication. Doxycycline, rifampicin, or a triple plus an ofloxacin tablet. Generally speaking, we need to take the medicine for half a year after surgery, and we can stop the medicine when various indicators and inflammatory indicators are under control.