Retrospective Analysis of the Efficacy and Safety of Endoscopic Spinal Tuberculosis and Brucellosis Lesion Removal and Posterior Pedicle Lesion Removal, Bone Grafting, Internal Fixation and Surgery Combined with Medical Chemotherapy in the Treatment of Spinal Tuberculosis and Brucellosis.

Abstract

Objective: To evaluate the clinical effectiveness of endoscopic removal of spinal infections and posterior pedicle surgery, including bone grafting, fixation, and chemotherapy, and to outline preventive strategies for complications, offering guidance for clinical practice.

Methods: 128 spinal infectious disease patients (2018-2022) were categorized into Group A (endoscopic removal, n=44) and Group B (posterior pedicle removal+bone grafting+fixation, n=84). Pre-surgery, all received quadruple antibiotic therapy. Metrics tracked: operation time, blood loss, drainage, recovery, stay, transfusion, complications, and pre/post-surgery VAS, ODI, ESR, CRP, PCT, D-dimer, NLR, Hb, albumin.

Results: (1) Preoperative data: There were no statistically significant differences in age, gender, body mass index, involved segments, past medical history (cardiovascular and cerebrovascular diseases, respiratory diseases, endocrine system diseases, metabolic diseases and tuberculosis), smoking history, preoperative erythrocyte sedimentation rate, C-reactive protein, procalcitonin, D-dimer, lymphocyte and neutrophil-lymphocyte ratio, hemoglobin, total protein, waist VAS score and waist ODI score (P>0.05). (2) The main postoperative indexes were significantly lower than those of group B at the last follow-up at 3 months and the last follow-up in group A, and the difference was significant (P<0.05), the hemoglobin and total protein in group A were significantly higher than those in group B at the last postoperative follow-up (P<0.05), and the recurrence rate in group B was significantly higher than that in group A, and the difference was significant (P=0.048). (3) Postoperative secondary indicators: the amount of blood transfusion in group A was significantly lower than that in group B, and the difference between the two groups was statistically significant (P<0.05), while the operation time, intraoperative blood loss and postoperative hospital stay in group A were significantly smaller than those in group B, and the difference between the two groups was statistically significant (P<0.05).

Conclusion: Endoscopic lesion removal for spinal infections achieves similar safety to posterior pedicle surgery, with shorter operation time, less blood loss, lower recurrence, and reduced drainage. It enhances ESR, spine function, and pain relief, meriting promotion.