Diagnosis and Treatment of Brucella Infection of the Cervical Vertebral Bodies and Intervertebral Discs

By Junhui Liu¹, Wenyuan Luo², Mingjia Song³

Affiliations

1. Department of Orthopaedics, Gansu University of Chinese Medicine, Lanzhou, China
2. Department of Orthopaedics, Gansu Provincial Hospital, Lanzhou, China
3. Department of Orthopaedics, The 940th Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army, Lanzhou, China

doi: 10.29271/jcpsp.2026.08.1093

Sir,

Brucellosis is the most common zoonotic disease. Particularly in endemic regions, spinal involvement is a major cause of morbidity and mortality. Diagnosis of brucellosis-induced spon-dylitis requires integration of microbiological and radiolo- gical findings. Available treatment options include antibiotics administered at adequate doses and for sufficient duration, supplemented by surgical intervention when indicated.¹ Spinal fusion demonstrates high clinical success rates in patients with brucellar spondylitis, effectively alleviating pain and improving function with a favourable prognosis.² Brucella- induced cervical spondylitis is rare but may lead to severe con- sequences without timely diagnosis and treatment.³

A 55-year male, who has long been engaged in cattle and sheep farming, presented to this hospital complaining of neck and shoulder pain and discomfort accompanied by weakness in both upper limbs for over 10 days, with symptoms worsening over the past 3 days.

Physical examination revealed limited cervical spine mobility, paraspinal muscle tension at the C5 and C6 vertebrae, mild tenderness over the spinous processes and paraspinal areas, grade III muscle strength with decreased muscle tone in the left upper limb, and grade IV muscle strength with normal muscle tone in the right upper limb. Cervical MRI revealed disc protrusion at C5/6 and C6/7 levels with corresponding spinal canal stenosis, posterior cervical spinal cord compression, and localised softening, loss of cervical lordosis, vertebral osteophytes, disc degeneration, and narrowing of the C5/6 inter- vertebral space (Figure 1A, B). Laboratory tests showed C- reactive protein of 54.25 mg/L, interleukin-6 of 134.48 pg/mL, procalcitonin of 0.152 ng/mL, and erythrocyte sedimentation rate of 44 mm/1^st hour. Brucella antibody detection was positive (tube agglutination). Brucella antibody detection was positive at 1:25. By tube agglutination, Brucella antibody detection was positive at 1:50 and 1:100. Based on imaging and laboratory findings, the diagnosis was made of Brucella cervical spondylitis.

Based on this diagnosis, standardised systemic antibiotic therapy was administered preoperatively, comprising oral doxycycline (100 mg twice daily) and rifampicin (600 mg once daily). The antibiotic regimen was planned to last at least 12 weeks. During the drug therapy, the patient was re- evaluated, and it was found that the patient had severe neurological impairment (limb weakness). The MRI showed obvious spinal cord compression. Hence, surgery was deemed necessary.

Figure 1: (A, B) Cervical MRI reveals disc protrusion at the C5/6 and C6/7 levels with corresponding spinal canal stenosis, posterior cervical spinal cord compression, and localised softening; loss of cervical lordosis, vertebral osteophytes, disc degeneration, and narrowing of the C5/6 intervertebral space. (C, D) Process of clearing cervical lesions to achieve adequate spinal cord decompression. (E) Fluoroscopy confirms the proper positioning of the cervical plate and screws. (F, G) Pathology report findings demonstrating chronic inflammatory changes accompanied by purulent inflammatory  pathological  alterations.

Following admission, the patient underwent cervical lesion resection under general anaesthesia, combined with a titanium cage and artificial bone implantation. The key to this treatment is complete debridement of the infected lesion and spinal de- compression, followed by biopsy of the diseased tissue. After satisfactory induction of general anaesthesia, the patient was positioned supine, and the surgical site was routinely disinfected and draped. The cervical spine underwent standard anterior approach surgery to expose the C5-C7 level. Positioning was performed at the C5 level under C-arm fluoroscopy. Under microscopic guidance, the C5/6 and C6/7 intervertebral discs were meticulously scraped out, followed by the removal of the C6 vertebral body. After excising the C6 vertebral body, approximately 2 mL of greyish-white thin fluid was observed flowing from the posterior longitudinal ligament, a critical intraoperative finding indicating infection. Inflammatory hyperplasia was observed posterior to the posterior longi- tudinal ligament and anterior to the dura mater, accompanied by significant spinal cord compression. During surgery, the posterior longitudinal ligament was removed, inflammatory hyperplastic tissue was thoroughly debrided, and cervical spinal canal decompression was achieved. Subsequently, iodine solution, hydrogen peroxide, and normal saline were repeatedly used for irrigation (Figure 1C, D). To reconstruct the cervical spine, a titanium cage of appropriate size was filled with a mixture of rifampicin powder and artificial bone graft material and implanted between the C5 and C7 vertebrae. Subsequently, a cervical anterior plate was secured to the C5 and C7 vertebrae using screws. Finally, the correct positioning of the implant was confirmed via fluoroscopy (Figure 1E). After confirming haemostasis, the drainage tube was placed, the wound was sutured layer by layer, and the operation was completed. On the second postoperative day, the patient reported significant symptom relief compared to preoperative status. At the 3-month follow-up, the patient had achieved near-complete recovery. The patient obtained satisfactory therapeutic outcomes. The postoperative pathology report indicated chronic inflammatory changes with purulent inflammatory pathology (Figure 1F, G). Intraoperative tissue culture subsequently confirmed the growth of Brucella.

Brucella spondylitis is a common complication of systemic brucellosis; however, its occurrence in the cervical spine is relatively rare. Its clinical manifestations are highly similar to cervical spondylosis and are often misdiagnosed or ignored. In this case, a suitably sized titanium cage was filled with a mixture of rifampicin powder and artificial bone graft material and then implanted between the C5 and C7 vertebral bodies. This local loading treatment method is also supported in clinical practice.⁴ When brucellar cervical spondylitis is diagnosed, oral medication is a common treatment approach. However, this method is suitable only for patients with mild, slowly progressing disease. When the condition advances rapidly, medication often proves ineffective. Moreover, relying solely on oral drugs can lead to drug resistance, significantly diminishing therapeutic efficacy. Therefore, surgery is indicated in patients with severe or progressive neurological defi-cits (such as limb weakness), significant spinal cord compression on MRI, and spinal instability or deformity, to prevent permanent  neurological  damage.

FUNDING:
This study receives funding from the Natural Science Foundation  of  Gansu  Province,  China  (22JR5RA681).

COMPETING  INTEREST:
The  authors  declared  no  conflict  of  interest.

AUTHORS’  CONTRIBUTIONS:
JL:  Drafted,  revised,  and  edited  the  manuscript.
WL:  Conducted  data  collection,  analysis,  and  interpretation.
MS:  Performed  data  collection.
All  authors  approved  the  final  version  of  the manuscript to be published.

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