Clinical efficacy of UBE-LIF versus posterior lesion removal bone graft fusion fixation in the treatment of lumbar brucelli spondylitis / 西安交通大学学报(医学版)

Objective To compare the safety and clinical efficacy of lesion removal combined with percutaneous pedicle screw fixation with classical posterior lesion removal in the treatment of lumbar brucelli spondylitis(LBS)by unilateral biportal endoscopic technique with transforaminal lumbar interbody fusion(UBE-LIF)technique.Methods The clinical data of 32 patients with LBS admitted by the Department of Spine and Orthopedics of Gansu Provincial Hospital of Traditional Chinese Medicine from January 2020 to January 2022 were retrospectively analyzed,and the clinical data of the 32 LBS patients were divided into 15 cases in the UBE-LIF group and 17 cases in the posterior group.The general data,surgery-related indexes,and postoperative pathological HE staining of the two groups were recorded and analyzed.The patients'clinical recovery was assessed according to their erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP),low back pain visual analogue score(VAS),Japanese Orthopaedic Association(JOA)score,and Oswestry Dysfunction Index(ODI)preoperative,1 week after surgery,1,3,6 months and 1 year after surgery.Lumbar lordosis angle(LL)and intervertebral space height(DH)were measured by imaging before surgery and at the last follow-up,and intervertebral bone graft fusion was assessed using Suk grading criteria.Results Both groups successfully completed the operation and no serious postoperative complications occurred.There were no significant differences in gender,age,surgical segment,operation time,preoperative ESR and CRP,preoperative VAS,JOA score and ODI index,preoperative LL and DH(P＞0.05).The intraoperative blood loss,postoperative drainage,postoperative getting out of bed,and postoperative hospital stay in UBE-LIF group were significantly lower than those in the posterior group(P＜0.001).Pathological examination of diseased tissues was performed during surgery,all of which was consistent with brucellosis changes.Patients in both groups were followed up for 12-18 months,with an average of 14.8 months.The VAS,JOA score,and ODI index at all postoperative time points in the two groups were significantly improved compared with the preoperative period(P＜0.05).The difference between the two groups was significantly greater than that in the postoperative group:VAS score was lower in UBE-LIF group than in the posterior group(P＜0.01),CRP in both groups was higher than that in the preoperative group,and the elevation level was significantly lower in UBE-LIF group than in the posterior group(P＜0.001).There was no significant difference in ESR between the two groups compared with that before surgery(P＞0.05).There were no significant differences in VAS,JOA score,ODI index,CRP or ESR between the remaining time points after surgery(P＞0.05).At the last follow-up,imaging examination showed that the overall fusion rate of intervertebral bone graft in UBE-LIF group was 93.3％and 94.1％in the posterior group,without significant difference(x2=0.246,P=0.884).LL and DH were significantly improved in both groups compared with preoperative ones(P＜0.01),and the two groups did not significantly differ before and after surgery(P＞0.05).Conclusion Both surgical treatments for LBS are safe effect.Compared with posterior lesion removal bone graft fusion internal fixation,UBE-LIF technology combined with percutaneous pedicle screw internal fixation has the advantages of clear intraoperative vision,less blood loss,faster early postoperative recovery,and shorter postoperative hospital stay,and thus is a feasible surgical method for the minimally invasive treatment of LBS.

Research progress in the diagnosis and treatment of Brucella spondylitis / 中华地方病学杂志

Brucellosis is a zoonotic disease caused by Brucella. Its typical clinical manifestations include fever, chills, fatigue, bone and muscle pain, etc. Brucellosis can affect multiple organs and tissues, of which spine is the most common affected part, forming Brucella spondylitis. Due to the clinical manifestations and imaging characteristics of infected individuals being similar to other spinal diseases, it is easy to cause misdiagnosis, missed diagnosis, and mistreatment. This article reviews the latest research progress in clinical manifestations, imaging examination, diagnosis, differential diagnosis, and treatment of Brucella spondylitis both domestically and internationally, in order to provide reference for the diagnosis and treatment of Brucella spondylitis.

A preliminary study of MRI-based radiomics combined with clinical features for Differential Diagnosis of Brucella Spondylitis and Pyogenic Spondylitis / 中华骨科杂志

Objective:To elucidate the diagnostic utility of clinical features and radiomics characteristics derived from magnetic resonance imaging T2-weighted fat-suppressed images (T2WI-FS) in differentiating brucellosis spondylitis from pyogenic spondylitis.Methods:Clinical records of 26 patients diagnosed with Brucellosis Spondylitis and 23 with Pyogenic Spondylitis were retrospectively reviewed from Xinjiang Medical University First Affiliated Hospital between January 2019 and December 2021. Confirmatory diagnosis was ascertained through histopathological examination and/or microbial culture. Demographic characteristics, symptoms, clinical manifestations, and hematological tests were collected, followed by a univariate analysis to discern clinically significant risk factors. For the radiomics evaluation, preoperative sagittal T2WI-FS images were utilized. Regions of interest (ROIs) were manually outlined by two adept radiologists. Employing the PyRadiomics toolkit, an extensive array of radiomics features encompassing shape, texture, and gray-level attributes were extracted, yielding a total of 1,500 radiomics parameters. Feature normalization and redundancy elimination were implemented to optimize the predictive efficacy of the model. Discriminatory radiomics features were identified through statistical methods like t-tests or rank-sum tests, followed by refinement via least absolute shrinkage and selection operator (LASSO) regression. An integrative logistic regression model incorporated selected clinical risk factors, radiomics attributes, and a composite radiomics score (Rad-Score). The diagnostic performance of three models clinical risk factors alone, Rad-Score alone, and a synergistic combination were appraised using a confusion matrix and receiver operating characteristic (ROC) analysis.Results:The cohort comprised 49 patients, including 36 males and 13 females, with a mean age of 53.79±13.79 years. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) emerged as significant clinical risk factors ( P<0.005). A total of seven discriminative radiomics features (logarithm glrlm SRLGLE, exponential glcm Imc1, exponential glcm MCC, exponential gldm SDLGLE, square glcm ClusterShade, squareroot glszm SALGLE and wavelet.HHH glrlm Run Variance) were isolated through LASSO regression. Among these selected features, the square glcmClusterShade feature exhibited the best performance, with an area under the curve (AUC) value of 0.780. It demonstrated a sensitivity of 68.8%, specificity of 94.4%, accuracy of 82.4%, precision of 91.7%, and negative predictive value of 0.773. Furthermore, the logarithm glrlm SRLGLE feature had an AUC of 0.736, sensitivity of 68.8%, specificity of 72.2%, accuracy of 76.5%, precision of 72.2%, and negative predictive value of 0.812. The exponential glcm Imc1 feature had an AUC of 0.736, sensitivity of 50.0%, specificity of 94.4%, accuracy of 73.5%, precision of 88.9%, and negative predictive value of 0.680. Three diagnostic models were constructed: the clinical risk factors model, the radiomics score model, and the integrated model (clinical risk factors+radiomics score), which showed AUC values of 0.801, 0.818, and 0.875, respectively. Notably, the integrated model exhibited superior diagnostic efficacy. Conclusion:The amalgamation of clinical and radiomics variables within a sophisticated, integrated model demonstrates promising efficacy in accurately discriminating between Brucellosis Spondylitis and Pyogenic Spondylitis. This cutting-edge methodology underscores its potential in facilitating nuanced clinical decision-making, precise diagnostic differentiation, and the tailoring of therapeutic regimens.

Value of CT grayscale histogram features in the differential diagnosis of brucella spondylitis and pyogenic spondylitis / 中国脊柱脊髓杂志

Objectives:To evaluate the values of sagittal CT image histogram features in the differential diagnosis of brucella spondylitis(BS)and pyogenic spondylitis(PS).Methods:The data of 40 BS patients[25 males,15 females;age:51.6±13.0 years old;body mass index(BMI):23(20,28)kg/m2,the BS group]and 33 PS patients[13 males,20 females;age:50.8±16.7 years old;BMI:23(20,26)kg/m2,the PS group]who underwent CT examination of the spine in our hospital and were confirmed through pathology and/or etiology were collected.The region of interest(ROI)was delineated on each level of the sagittal CT images of the two groups of patients by using the 3D Slicer platform and grayscale global histogram analysis was performed.The clinical data were compared using chi square test,independent sample t-test,and Mann Whitney U test between the two groups of patients;Univariate analysis,correlation analysis,and multivariate analysis were used in sequence to identify the histogram features with significant differences between the two groups(including 10％percentile,1％percentile,25％percentile,5％percentile,median,minimum,skewness,and variance);Logistic regression and the screened features were combined for modeling,and receiver operating characteristic(ROC)curves were drawn and areas under the curve(AUC)were calculated to compare the discriminative ability of each histogram feature.Results:There was no statistically significant difference in age,gender,and BMI between the two groups of patients(P＞0.05).Among the histogram parameters,10％percentile value,1％percentile value,25％percentile value,5％percentile value,median,minimum value,skewness,and variance were statistically different between the two groups(P＜0.05).The 10％percentile value displayed the best diagnostic performance,with an AUC value of 0.824 and a specificity of 0.893.The combined model had an AUC value of 0.860 and a specificity of 0.946.Conclusions:Based on 10％percentile value of CT grayscale histogram and joint model,PS and BS can be distinguished effectively,providing a basis for accurately distinguishing the two diseases in clinical practice.

Values of Apparent Diffusion Coefficient and Fractional Anisotropy in the Diagnosis of Brucella Spondylitis / 中国医学科学院学报

To compare the differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) between brucella spondylitis (BS) groups at different stages before treatment and the normal control group and to evaluate the change trend of ADC value and FA value at different time points before and after treatment. Totally 53 patients suspected of BS by conventional magnetic resonance imaging (MRI) and later confirmed as BS patients by serological tests were enrolled in this study. These patients underwent conventional MRI and diffusion tensor imaging scans,and the ADC value and FA value were measured. Independent sample test was used to compare the ADC value and FA value between the BS group and the control group,the ADC value and FA value between the BS group at each stage. Repeated measurement ANOV was used to compare the ADC values and FA values at different time points before and after treatment. FA imaging showed that the color code of BS was different from that of the normal control group,and the color code of FA imaging showed increased singal. The ADC values of BS in the acute,subacute,and chronic stages [(1.45±0.02)×10 mm /s,(1.35±0.03)×10 mm /s,(1.26±0.05)×10 mm /s,respectively] were significantly higher than those in the control group [(1.06±0.09) ×10 mm /s](=2.538,=0.009;=1.998,=0.032;=1.575,=0.004),and the FA value (0.55±0.02,0.65±0.03,0.71±0.04,respectively) were significantly lower than those of the control group (0.78±0.02) (=2.440,=0.012; =1.847,=0.041;=2.102,=0.003). Repeated measurement analysis showed that there were statistically significant differences in ADC values and FA values at different time points before and after treatment in the acute,subacute,and chronic stages (ADC:=12.100,<0.001;=8.439,=0.005;=9.704,=0.004,respectively;FA:=7.080,=0.002;=6.607;=0.003;=8.868,=0.001,respectively). The ADC values at different time points after treatment were significantly lower than those before treatment or at a previous time point after treatment (=332.14,<0.001),and the FA values were significantly higher than those before treatment or at a previous time point after treatment (=134.26,<0.001). FA color code can intuitively display differences in BS and normal vertebral bodies and show change of color code before and after treatment. Also,the ADC values and FA values can quantitatively reveal differences between BS and normal vertebral body in different time points and quantify BS vertebral lesion changes before and after treatment. In particular,in BS patients who are recovering from treatment,it can quantify microscopic edema. Therefore,diffusion tensor imaging may be useful objective indicator in evaluating the effectiveness of a specific treatment for BS.

MRI differential diagnosis of Brucella spondylitis and spinal tuberculosis / 实用放射学杂志

Objective To analyze the MRI features of Brucella spondylitis and spinal tuberculosis,to improve the ability of differential diagnosis. Methods MRI features of 22 cases with Brucella spondylitis and 26 cases with spinal tuberculosis confirmed by laboratory examination and operative pathology were analyzed retrospectively.Results Among 22 cases of Brucella spondylitis,1 7 cases occurred in the lumbar spine (1 3 cases in the lumbar 4 vertebrae),2 cases in the cervical spine,2 cases in the thoracic spine and 1 case in the sacral spine.1 9 cases had normal vertebral morphology,slight bone destruction and extensive edema,3 cases had severe vertebral wedge deformation, 16 cases had marginal bone hyperplasia.15 cases had slight changes in the intervertebral space,with narrow (or normal)or slight destruction of intervertebral disc,7 cases had severe narrowing or disappearance of intervertebral space and serious destruction of intervertebral disc. 13 cases had small paravertebral abscess,and 1 case had large paravertebral abscess.Among 26 cases of spinal tuberculosis,20 cases occurred in the lumbar spine (11 cases in the 4th and 5th vertebral bodies),5 cases occurred in the thoracic spine and 1 case occurred in the sacral spine,21 cases had severe vertebral wedge deformation due to bone destruction,9 cases had slight narrowing of intervertebral space, slight destruction of intervertebral discs,and 1 7 cases had obvious narrowing or narrowing of intervertebral space.7 cases had small paravertebral abscess and 1 6 cases had large paravertebral abscess with flowing phenomenon.Conclusion Vertebral morphology of Brucella spondylitis is basically normal,bone destruction is light and edema range is large,bone hyperplasia is common,slight narrowing (or normal)of intervertebral space occurs in intervertebral disc with less destruction,range of paravertebral abscess is limited.Bone destruction of spinal tuberculosis is heavy and edema range is small,vertebral body is easy to deform with no osteoporosis,significant stenosis (or disappearance)and severe disruption occur in intervertebral disc,paravertebral abscess is large often with flowing phenomenon.

Efficacy of thoracolumbar single segment of Brucella spondylitis TLIF surgery / 西安交通大学学报(医学版)

Objective To investigate clinical efficacy of transforaminal approach debridement with fusion,thoracolumbar single segment of Brucella spondylitis pedicle screw fixation (TLIF surgery).Methods We analyzed retrospectively the clinical data of 28 patients with Brucella spondylitis treated in our department between January 2009 and January 2014 with TLIF surgery (Group A) and internal fixation with a simple posterior anterior interbody disease debridement,autogenous bone graft (Group B).The two groups were compared in operation time,blood loss,postoperative ambulation time,hospitalization days,erythrocyte sedimentation rate (ESR),Creactive protein (CRP),American Spinal Injury Association (ASIA) classification,visual analogue scale (VAS),Oswestry Disability Index (ODI),Cobb angle of vertebral bone graft healing,and complications.Results All the patients were followed up for an average of 20.2 months (18 to 27 months).They were all cured.Compared with those in Group B,patients in Group A had shorter operation time (164.60±59.19)min,significantly reduced blood loss (346.00±108.90)mL and complications (1 case);significantly shorter postoperative ambulation time (3.36±1.11 days),hospitalization days (17.36 ± 4.19) days and duration (13.16 ± 3.94) months (P ＜ 0.05).The two groups did not significantly differ in VAS scores,ODI,ESR CRP,or Cobb angle (P＞0.05).Conclusion On the basis of norms of anti-drug treatment for brucellosis,TLIF surgery on Brucella spondylitis has the advantages including less trauma,shorter operation time,easier operation,less bleeding,earlier postoperative ambulation,and lower complication rate.

Evaluation on therapeutic value of MRI for cervical Brucella spondylitis / 实用放射学杂志

Objective To discuss MRI diagnositic value and evaluation of the treatment of cervical Brucella spondylitis(BS).Meth-ods MRI data of 39 cases with cervical BS in our hospital were collected.Non-operative treatment,minimal invasive surgery and the open surgery were selected according to the MRI manifestations.The correlation was analyzed by consistensy check,imaging score and clinical effect evaluation.The data were analyzed by SPSS15.0.Results 39 cases of patients were examined by MRI before the treatment.37 cases were reviewed after 6 months treatment and 33 cases were reviewed after 12 months treatment.All of the Kappa values were more than 0.75 by imaging consistency check.MRI of cervical BS possessed characteristic expressions.The treatment effect according to MRI classification before the treatment:(1)drug therapy was performed in 14 cases (Group A);(2)minimal inva-sive surgery was performed in 7 cases (Group B);(3)focus clearance and bone graft were performed in 18 cases (Group C);(4)the clinical effects showed the healing rate in every group at different time point was different and the difference had statistical signifi-cance(P0.05). Conclusion MRI classification for cervical BS has important value and guiding significance in the selection of clinical conservative treatment,minimal invasive surgery or the open surgery.

Brucellar and tuberculous spondylitis:a comparative study of their imaging features / 中华传染病杂志

Objective To analyze and discuss the different characteristics of clinical imaging of Brucellar and tuberculous spondylitis,and to improve the diagnostic performance of the image of Brucellar spondylitis.Methods A retrospective analysis at Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University was conducted from January 2011 to December 2013.X-ray,computer tomography (CT)and magnetic resonance imaging (MRI)data of 46 cases of Brucellar spondylitis and 40 cases of tuberculous spondylitis were compared.Results The lumbar spine,especially L4,was usually involved in brucellosis,characterized with multiple small lesions mostly confined to the edge of vertebral body and surrounded by the hyperplasia and sclerosis.New damaged foci were formed in the new bone tissue and intervertebral discs destruction was slight with hyperplasia and sclerosis of articular surface. Few or no paravertebral abscesses were seen.In contrast,thoracic and lumbar spines were more usually affected in tuberculosis featured with destruction of vertebra and intervertebral discs.There could be dead bone formation.Paravertebral abscesses and osteoporosis were frequent.Conclusion The different imaging characteristics of Brucellar and tuberculous spondylitis could favor the differential diagnosis.