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Establishment of Standardized Diagnostic System for Brucella Spondylitis in the Elderly and Clinical Application of Precise Treatment Strategy

Received: 4 April 2023    Accepted: 21 April 2023    Published: 27 April 2023
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Abstract

Objectives Establish a clinical standardized diagnosis and treatment strategy system for senile brucellosis spondylitis, and evaluate the clinical effect of applying this diagnosis and treatment system in order to improve the diagnosis rate and cure rate of the disease. Methods A diagnostic system was established based on the medical history, clinical, imaging, laboratory, bacteriological and pathological examinations of 70 elderly patients with brucellosis spondylitis admitted from January 2002 to December 2017. All patients received standardized drug therapy, anti-osteoporosis therapy and adjuvant hyperbaric oxygen therapy. Forty-two patients with spinal nerve injury received surgical treatment. Follow-up and evaluation were conducted at 2 weeks, 1 month, 3 months, 6 months, and 12 months after treatment. Results All patients were diagnosed after admission according to the diagnostic system standard examination. In this group, 28 patients (40%) received standardized drug therapy for non-surgical indications (group A), and 42 patients (60%) received surgical treatment for surgical indications (group B). VAS scores were significantly different between the two groups (P<0.05), group B was better than group a. Imaging scores showed that in group B, the myelopathy segments were stable without abscess and inflammatory granuloma, except for slow bone repair in the debridement area of the original myelopathy. Group A had no obvious vertebral lesion infiltration and interstitial infection absorption after 3 months of treatment, and gradually absorbed vertebral inflammatory infiltration and interstitial infection after 6 months. Clinical efficacy evaluation showed that both groups achieved good cure rates over time, and group B was better than group A (P<0.05). Conclusion Elderly brucellosis spondylitis has characteristic manifestations, and the establishment of a standardized diagnosis system will help improve the diagnosis rate; Synchronous drug therapy for BS and osteoporosis according to the treatment strategy has a good effect, and for patients who meet the indications for surgery, timely surgery can relieve or relieve pain, maintain spinal stability, and promote rapid recovery of nerve and spinal functions. It has obvious advantages and can better improve the clinical cure rate.

Published in Clinical Medicine Research (Volume 12, Issue 2)
DOI 10.11648/j.cmr.20231202.11
Page(s) 19-29
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Brucellosis, Spondylitis, Standardized Diagnosis, Treatment Strategy, Diagnosis and Treatment System, Clinical Evaluation

References
[1] Xin-ming Yang, Xian-yong Meng, Wei Shi, et al. The Comparison of the Manifestation of the Clinical Imageology and Pathology between the Brucellar Spondylitis and the Spine Turberculosis [J]. Scientific Research, 2014, 5 (2): 60-69. DOI: 10.4236/ss.2014.52014.
[2] Yang Xin-ming, Wei Shi, Wang Xiao-yi, et al. Imaging Classification and Clinical Significance of Brucellosis Spondylitis [J]. J Spine, 2014, 3 (3): 172-177. DOI: 10.4172/2165-7939.1000172.
[3] Xin-Ming Yang, Wei Shi, Xian-Yong Meng, et al. The Assessment of the Clinical Effect of the Drug Compatibility and Course of Treatment to the Brucellar Spondyliti [J]. Scientific Research, 2013, 4 (1): 92-99. DOI: 10.4236/ss.2013.41017.
[4] Saltoglu N, Tasova Y, Inal AS, et al. Efficacy of rifampicin plus doxycycline versus rifa mpicin plus quinolone in the treatment of brucellosis [J]. Saudi Med J, 2002, 23 (8): 921-924. PMID: 12235463.
[5] Xin-ming Yang, Ying Zhang, Xian-yong Meng, et al. Clinical Effect of Hyperbaric Oxygen Intervention on Brucellosis Spondylitis [J]. Chinese Journal of Nautical Medicine and Hyperbaric Medicine, 2013, 20 (6): 348-351. DOI: 10.3760/cma.j.issn.1009-6906.2013.04.008.
[6] Xin-ming Yang, Xian-yong Meng, Chang-bo Hu, et al. Diagnostic and Therapeutic Value of MRI Image Typing in Brucellosis Spondylitis. Chinese Journal of Anatomy and Clinics, 2016, 21 (2): 101-108. DOI: 10.3760/cma.j.issn.2095-7041.2016.02.003.
[7] Xin-ming Yang, Wei Shi, Ya-kun Du, et al. Clinical Imaging Findings and Surgical Treatment of Brucellosis Spondylitis [J]. Chinese Journal of Orthopedics, 2008, 28 (1): 35-40. DOI: 10.3321/j.issn:0253-2352.2008.01.008.
[8] Xian-Yong Meng, Xin-Ming Yang, Peng Zhang, Chang-bo Hu. Observation of 38 Cases of Brucellar Spondylitis with Nerve Damage [J]. Orthopedic Journal of China, 2015, 23 (5): 393-401. DOI: 10.3977/j.issn.1005-8478.2015.05.03.
[9] Turgut M, Turgut AT, Kosar U. “Spinal brucellosis: Turkish experience based on 452 case published during the last century”. Acta Neurochir, 2006, 148 (10): 1033-1044. DOI: 10.1007/S00701-006-0877-3.
[10] Peng Zhang, Xin-Ming Yang, Xian-Yong Meng. Progress in Diagnosis and Treatment of Brucobacterial Spondylitis [J]. Chinese Journal of Spine and Spinal Cord, 2013, 23 (11): 1029-1032. DOI: 10.3969/j.issn.1004-406X.2013.11.15.
[11] Merdan•Mermaiti, Jusn Tian, Wei-bin Sheng, et al. Diagnosis and Surgical Treatment of Brucellosis Spondylitis [J]. Chinese Journal of Orthopaedics, 2012, 32 (4): 323-330. DOI: 10.3760/cma.j.issn.0253-2352.2012.04.006.
[12] Ye Zhang, Xin-Ming Yang, Wei Shi, et al. Diagnosis and Treatment of Lumbar Brucellosis Spondylitis [J/CD]. Chinese Journal of Experimental and Clinical Infectious Diseases (Electronic Edition), 2014, 8 (4): 8-13. DOI: 10.3877/cma.j.issn.1674-1358.2014.04.003.
[13] Xin-Ming Yang, Wei Shi, Ya-kun Du, et al. Clinical Observation of Brucellar Spondylitis [J]. Chinese Jouranl of Endemiology, 2008, 27 (6): 699-703. DOI: 10.3760/cma.j.issn.1000-4955.2008.06.034.
[14] Solera J, Geijo P, Largo J, et al. Arandomized, double-blind study to assess the optimal duration of doxycycline treatment for human brucellosis [J]. Clin Infect Dis, 2004, 39 (12): 1776-1782. DOI: 10.1086/426024.
[15] Xin-Ming Yang, Wei Shi, Xian-yong Meng, etal. Reevaluation of the Effect of Drug Compatibility and Course of Treatment on Clinical Efficacy of Brucellosis Spondylitis [J]. Chinese Journal of Modern Applied Pharmacy, 2013, 30 (7): 776-781.
[16] David N. Gilbert, Robert C. Moellering, George M. Eliopoulous, Merle A. Sande. The Sanford guided to antimicrobial therapy [S]. 34edition. Antimicrobial Theraphy, Incorpora. 2004. 40, 48-51.
[17] Ioannou S, Karadima D, Pneumaticos S, et al. Efficacy of prolonged antimicrobial chemotherapy for brucellar spondylodiskitis [J]. Clin Microbiol Infect, 2011, 17 (5): 756-762. DOI: 10.1111/j.1469-0691.2010.03272.x.
[18] Seyed M, Mohammad R, Nasser J, etal. Outcomes of treatment in 50 cases with spinal brucellosis in Babol, Northern Iran [J]. Infect Dev Ctries, 2012, 6 (9): 654-659. DOI: 10.3855/jidc.2175.
[19] Xin-Ming Yang, Xian-yong Meng, Ying Zhang, etal. Surgical Treatment of Thoracolumbar Brucellosis Spondylitis [J]. Chinese Journal of Spine and Spinal Cord, 2012, 23 (10): 1055-1058. DOI: 10.3969/j.issn.1004-406X.2012.07.05.
[20] Xin-Ming Yang, Lei Zhang, Ying Zhang, etal. Treatment of Thoracolumbar Brucellosis Spondylitis by Primary Debridement Combined with Posterior Pedicle Internal Fixation [J]. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26 (3): 266-271. DOI: CNKI:51-1372/R.20120229.0859.003.
[21] Pina MA, Modrego PJ, Uroz JJ, Cobeta JC, Lerin FJ, Baiges JJ. Brucellar spinal epidural abscess of cervical location: report of four cases. Eur Neurol. 2001; 45 (4): 249-53. doi: 10.1159/000052137.
[22] Atonis P, Tzermiadianos M, Gikas A, et al. Surgical treatment of spinal brucellosis [J]. Clin Orthop Relat Res, 2006, 444 (3): 66-72. DOI: 10.1097/01.blo.0000203455.59393.9a.
[23] Xin-Ming Yang, Lei Zhang, Yong-li Jia, etal. Comparison of Efficacy of Posterior and Anterior Approaches Combined with Debridement and Bone Grafting in Treatment of Lumbar Brucellosis Spondylitis [J]. Chinese Journal of Anatomy and Clinics, 2015, 20 (5): 428-434. DOI: 10.3760/cma.j.issn.2095-7041.2015.05.013.
[24] Bouaziz MC, Bougamra I, Kaffel D, et al. Noncontiguous multifocal spondylitis: an exceptional presentation of spinal brucellosis. Tunis Med, 2010, 88 (4): 280-284. PMID: 20446265.
[25] Chang-bo Hu, Xin-Ming Yang. Treatment of Single Space Lumbar Brucellosis Spondylitis with One-stage Posterior Debridement and Short Segment Internal Fixation with Intervertebral or Interarticular Bone Graft [J]. Chinese Journal of Anatomy and Clinics, 2018, 23 (2): 110-116. DOI: 10.3760/cma.j.issn.2095-7041.2018.02.005.
[26] Xin-ming Yang, Xian-yong Meng, Chang-bo Hu, et al. Standardized Diagnosis and Surgical Treatment of Brucellosis Spondylitis [J]. Chinese Journal of Bone and Joint Surgery, 2015, 21 (2): 110-114. DOI: 10.3969/j.issn.2095-9958.2016.04-09.
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  • APA Style

    Yang Xinming, Zhang Zhe, Yang Chaowei, Zhang Xuyang. (2023). Establishment of Standardized Diagnostic System for Brucella Spondylitis in the Elderly and Clinical Application of Precise Treatment Strategy. Clinical Medicine Research, 12(2), 19-29. https://doi.org/10.11648/j.cmr.20231202.11

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    ACS Style

    Yang Xinming; Zhang Zhe; Yang Chaowei; Zhang Xuyang. Establishment of Standardized Diagnostic System for Brucella Spondylitis in the Elderly and Clinical Application of Precise Treatment Strategy. Clin. Med. Res. 2023, 12(2), 19-29. doi: 10.11648/j.cmr.20231202.11

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    AMA Style

    Yang Xinming, Zhang Zhe, Yang Chaowei, Zhang Xuyang. Establishment of Standardized Diagnostic System for Brucella Spondylitis in the Elderly and Clinical Application of Precise Treatment Strategy. Clin Med Res. 2023;12(2):19-29. doi: 10.11648/j.cmr.20231202.11

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  • @article{10.11648/j.cmr.20231202.11,
      author = {Yang Xinming and Zhang Zhe and Yang Chaowei and Zhang Xuyang},
      title = {Establishment of Standardized Diagnostic System for Brucella Spondylitis in the Elderly and Clinical Application of Precise Treatment Strategy},
      journal = {Clinical Medicine Research},
      volume = {12},
      number = {2},
      pages = {19-29},
      doi = {10.11648/j.cmr.20231202.11},
      url = {https://doi.org/10.11648/j.cmr.20231202.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20231202.11},
      abstract = {Objectives Establish a clinical standardized diagnosis and treatment strategy system for senile brucellosis spondylitis, and evaluate the clinical effect of applying this diagnosis and treatment system in order to improve the diagnosis rate and cure rate of the disease. Methods A diagnostic system was established based on the medical history, clinical, imaging, laboratory, bacteriological and pathological examinations of 70 elderly patients with brucellosis spondylitis admitted from January 2002 to December 2017. All patients received standardized drug therapy, anti-osteoporosis therapy and adjuvant hyperbaric oxygen therapy. Forty-two patients with spinal nerve injury received surgical treatment. Follow-up and evaluation were conducted at 2 weeks, 1 month, 3 months, 6 months, and 12 months after treatment. Results All patients were diagnosed after admission according to the diagnostic system standard examination. In this group, 28 patients (40%) received standardized drug therapy for non-surgical indications (group A), and 42 patients (60%) received surgical treatment for surgical indications (group B). VAS scores were significantly different between the two groups (P<0.05), group B was better than group a. Imaging scores showed that in group B, the myelopathy segments were stable without abscess and inflammatory granuloma, except for slow bone repair in the debridement area of the original myelopathy. Group A had no obvious vertebral lesion infiltration and interstitial infection absorption after 3 months of treatment, and gradually absorbed vertebral inflammatory infiltration and interstitial infection after 6 months. Clinical efficacy evaluation showed that both groups achieved good cure rates over time, and group B was better than group A (P<0.05). Conclusion Elderly brucellosis spondylitis has characteristic manifestations, and the establishment of a standardized diagnosis system will help improve the diagnosis rate; Synchronous drug therapy for BS and osteoporosis according to the treatment strategy has a good effect, and for patients who meet the indications for surgery, timely surgery can relieve or relieve pain, maintain spinal stability, and promote rapid recovery of nerve and spinal functions. It has obvious advantages and can better improve the clinical cure rate.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Establishment of Standardized Diagnostic System for Brucella Spondylitis in the Elderly and Clinical Application of Precise Treatment Strategy
    AU  - Yang Xinming
    AU  - Zhang Zhe
    AU  - Yang Chaowei
    AU  - Zhang Xuyang
    Y1  - 2023/04/27
    PY  - 2023
    N1  - https://doi.org/10.11648/j.cmr.20231202.11
    DO  - 10.11648/j.cmr.20231202.11
    T2  - Clinical Medicine Research
    JF  - Clinical Medicine Research
    JO  - Clinical Medicine Research
    SP  - 19
    EP  - 29
    PB  - Science Publishing Group
    SN  - 2326-9057
    UR  - https://doi.org/10.11648/j.cmr.20231202.11
    AB  - Objectives Establish a clinical standardized diagnosis and treatment strategy system for senile brucellosis spondylitis, and evaluate the clinical effect of applying this diagnosis and treatment system in order to improve the diagnosis rate and cure rate of the disease. Methods A diagnostic system was established based on the medical history, clinical, imaging, laboratory, bacteriological and pathological examinations of 70 elderly patients with brucellosis spondylitis admitted from January 2002 to December 2017. All patients received standardized drug therapy, anti-osteoporosis therapy and adjuvant hyperbaric oxygen therapy. Forty-two patients with spinal nerve injury received surgical treatment. Follow-up and evaluation were conducted at 2 weeks, 1 month, 3 months, 6 months, and 12 months after treatment. Results All patients were diagnosed after admission according to the diagnostic system standard examination. In this group, 28 patients (40%) received standardized drug therapy for non-surgical indications (group A), and 42 patients (60%) received surgical treatment for surgical indications (group B). VAS scores were significantly different between the two groups (P<0.05), group B was better than group a. Imaging scores showed that in group B, the myelopathy segments were stable without abscess and inflammatory granuloma, except for slow bone repair in the debridement area of the original myelopathy. Group A had no obvious vertebral lesion infiltration and interstitial infection absorption after 3 months of treatment, and gradually absorbed vertebral inflammatory infiltration and interstitial infection after 6 months. Clinical efficacy evaluation showed that both groups achieved good cure rates over time, and group B was better than group A (P<0.05). Conclusion Elderly brucellosis spondylitis has characteristic manifestations, and the establishment of a standardized diagnosis system will help improve the diagnosis rate; Synchronous drug therapy for BS and osteoporosis according to the treatment strategy has a good effect, and for patients who meet the indications for surgery, timely surgery can relieve or relieve pain, maintain spinal stability, and promote rapid recovery of nerve and spinal functions. It has obvious advantages and can better improve the clinical cure rate.
    VL  - 12
    IS  - 2
    ER  - 

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Author Information
  • Department of Orthopaedics, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China

  • Department of Orthopaedics, Graduate School of Hebei North University, Zhangjiakou, China

  • Department of Orthopaedics, Graduate School of Hebei North University, Zhangjiakou, China

  • Department of Orthopaedics, Graduate School of Hebei North University, Zhangjiakou, China

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