case_images: PMC11150549_01
case_images: Case 1 CT and MRI manifestations of thoracic brucellosis spondylitis (T9-T10). (A-C) CT: T9, T10 vertebral bone destruction, intervertebral space narrowing. (D-F) MRI: T9-T10 vertebral body signal abnormality, vertebral body destruction with abscess, thoracic spinal cord compression. Case 2 X-ray, CT, and MRI findings of brucellosis spondylitis. (G) X-ray L1-L2 intervertebral space significantly narrowed. (H,I) CT showed worm-like bone destruction at L1-L2. (J-L) MRI showed inflammatory changes in the disk and vertebral body at L1-L2, abnormal high signal intensity, narrowing of the disk space, abscess formation, inflammatory tissue protruding into the spinal canal, and spinal cord compression.
case_images: fpubh-12-1396152-g001.jpg
case_images: PMC11150549_02_fpubh-12-1396152-g001.jpg
case_images: fig1
case_images: A positive Rose Bengal plate test (RBPT) and an MRI revealed inflammatory changes and structural destruction in the lumbar vertebrae 1 and 2, leading to a diagnosis of brucellosis spondylitis (Figures 1G-L).
case_images: Case 1 Surgical procedure of case 1 with thoracic brucellosis. (A,B) Positioning pins were placed in T9 and T10 vertebral bodies. (C,D) Intervertebral foraminal sleeve was placed in T9 and T10 intervertebral spaces under C-arm fluoroscopy. (E-G) Lesions were cleared under intervertebral foraminal scope. (H) Abscess lesions were cleared and sent to pathology. (I) Pedicle screws T9 and T10 were placed under direct vision, totaling 4. Case 2 Operative procedure for patient with lumbar brucellosis spondylitis. (J,K) A total of eight pedicle screws were placed at T12, L1, L2, and L3, and an intervertebral foraminal sleeve was placed at L1-L2. (L,M) Focus was cleared under the intervertebral foraminoscope. (N) The abscess focus was cleared and sent to pathology. (O) Approximately 4 mL of blood was extracted from a 20 mL empty needle for culture.
case_images: fpubh-12-1396152-g002.jpg
case_images: PMC11150549_02_fpubh-12-1396152-g002.jpg
case_images: fig2
case_images: Diseased intervertebral disk material was meticulously cleared using a bone file and curette, with rifampicin and bone graft particles implanted into the intervertebral space to ensure stability and promote healing (Figures 2J-O).
case_images: (A,B) HE staining showed the extensive infiltration of inflammatory cells (oil immersion, 40x magnification). (C,D) Gram staining of the nucleus pulposus reveals a significant number of Brucella (oil immersion, 100x magnification). Gram staining of the nucleus pulposus revealed the presence of small Gram-negative coccobacilli, consistent with Brucella organisms. (E) Real-time PCR of case 1 detects Brucella melitensis DNA at the 34th cycle. (F)
  Brucella melitensis and Brucella bovis (Brucella in cattle) DNA were detected in the 27th and 31st cycles of real-time PCR in case. (G) X-ray results of patient 1 at 4 weeks postoperatively. (H) X-ray of patient 2 at 12 weeks postoperatively.
case_images: fpubh-12-1396152-g003.jpg
case_images: PMC11150549_02_fpubh-12-1396152-g003.jpg
case_images: fig3
case_images: HE staining clearly shows the extensive infiltration of inflammatory cells, which is a hallmark of Brucella spondylitis (Figure 3B), and Gram staining revealed numerous Brucella (Figure 3D). The real-time PCR tests identified the DNA of both Brucella melitensis and Brucella bovis (Brucella abortus in cattle), confirming the dual infection (Figure 3F). Following surgery, the patient continued the anti-brucellosis medication for 6 weeks at the same preoperative dosage; 4 weeks postoperatively, the patient returned for follow-up, where X-rays and a three-dimensional CT scan of the lumbar spine showed substantial relief from pain, and he reported free movement of the lower limbs, marking a significant improvement in his quality of life (Figure 3H).
case_images: PMC11150549_02
case_images: Case 1 CT and MRI manifestations of thoracic brucellosis spondylitis (T9-T10). (A-C) CT: T9, T10 vertebral bone destruction, intervertebral space narrowing. (D-F) MRI: T9-T10 vertebral body signal abnormality, vertebral body destruction with abscess, thoracic spinal cord compression. Case 2 X-ray, CT, and MRI findings of brucellosis spondylitis. (G) X-ray L1-L2 intervertebral space significantly narrowed. (H,I) CT showed worm-like bone destruction at L1-L2. (J-L) MRI showed inflammatory changes in the disk and vertebral body at L1-L2, abnormal high signal intensity, narrowing of the disk space, abscess formation, inflammatory tissue protruding into the spinal canal, and spinal cord compression.
case_images: fpubh-12-1396152-g001.jpg
case_images: PMC11150549_02_fpubh-12-1396152-g001.jpg
case_images: fig1
case_images: A positive Rose Bengal plate test (RBPT) and an MRI revealed inflammatory changes and structural destruction in the lumbar vertebrae 1 and 2, leading to a diagnosis of brucellosis spondylitis (Figures 1G-L).
case_images: Case 1 Surgical procedure of case 1 with thoracic brucellosis. (A,B) Positioning pins were placed in T9 and T10 vertebral bodies. (C,D) Intervertebral foraminal sleeve was placed in T9 and T10 intervertebral spaces under C-arm fluoroscopy. (E-G) Lesions were cleared under intervertebral foraminal scope. (H) Abscess lesions were cleared and sent to pathology. (I) Pedicle screws T9 and T10 were placed under direct vision, totaling 4. Case 2 Operative procedure for patient with lumbar brucellosis spondylitis. (J,K) A total of eight pedicle screws were placed at T12, L1, L2, and L3, and an intervertebral foraminal sleeve was placed at L1-L2. (L,M) Focus was cleared under the intervertebral foraminoscope. (N) The abscess focus was cleared and sent to pathology. (O) Approximately 4 mL of blood was extracted from a 20 mL empty needle for culture.
case_images: fpubh-12-1396152-g002.jpg
case_images: PMC11150549_02_fpubh-12-1396152-g002.jpg
case_images: fig2
case_images: Diseased intervertebral disk material was meticulously cleared using a bone file and curette, with rifampicin and bone graft particles implanted into the intervertebral space to ensure stability and promote healing (Figures 2J-O).
case_images: (A,B) HE staining showed the extensive infiltration of inflammatory cells (oil immersion, 40x magnification). (C,D) Gram staining of the nucleus pulposus reveals a significant number of Brucella (oil immersion, 100x magnification). Gram staining of the nucleus pulposus revealed the presence of small Gram-negative coccobacilli, consistent with Brucella organisms. (E) Real-time PCR of case 1 detects Brucella melitensis DNA at the 34th cycle. (F)
  Brucella melitensis and Brucella bovis (Brucella in cattle) DNA were detected in the 27th and 31st cycles of real-time PCR in case. (G) X-ray results of patient 1 at 4 weeks postoperatively. (H) X-ray of patient 2 at 12 weeks postoperatively.
case_images: fpubh-12-1396152-g003.jpg
case_images: PMC11150549_02_fpubh-12-1396152-g003.jpg
case_images: fig3
case_images: HE staining clearly shows the extensive infiltration of inflammatory cells, which is a hallmark of Brucella spondylitis (Figure 3B), and Gram staining revealed numerous Brucella (Figure 3D). The real-time PCR tests identified the DNA of both Brucella melitensis and Brucella bovis (Brucella abortus in cattle), confirming the dual infection (Figure 3F). Following surgery, the patient continued the anti-brucellosis medication for 6 weeks at the same preoperative dosage; 4 weeks postoperatively, the patient returned for follow-up, where X-rays and a three-dimensional CT scan of the lumbar spine showed substantial relief from pain, and he reported free movement of the lower limbs, marking a significant improvement in his quality of life (Figure 3H).