{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:30:29Z","timestamp":1787027429108,"version":"build-2736575974"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T00:00:00Z","timestamp":1672963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to investigate the effectiveness and feasibility of biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis (LBS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The data of 13 patients with LBS were retrospectively analyzed, who underwent biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation from May 2020 to June 2022. The patients\u2019 clinical data, the duration of operation, the estimated blood loss (including postoperative drainage), and complications were recorded. Clinical outcomes include serum agglutination test (SAT) measures Brucella antibody titer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analog scale (VAS) scores of low back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), American Spinal Injury Association neurological classification, and lordotic angle were analyzed. All patients were assessed using the modified Macnab criteria at the final follow-up. The intervertebral bone graft fusion was assessed using the Bridwell grading criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean operation duration was 177.31\u2009\u00b1\u200919.54\u2005min, and the estimated blood loss was 176.15\u2009\u00b1\u200943.79\u2005ml (including postoperative drainage was 41.15\u2009\u00b1\u200910.44\u2005ml). The mean follow-up period was 13.92\u2009\u00b1\u20091.5 months. SAT showed that the antibody titers of 13 patients were normal 3 months after the operation and at the final follow-up. ESR and CRP levels returned to normal by the end of the 3-month follow-up. VAS scores of low back and leg, JOA score, and ODI significantly improved after the operation throughout the follow-up period (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). Based on the modified Macnab criteria, 92.3% showed excellent to good outcomes. One patient had only a percutaneous screw internal fixation on the decompression side due to severe osteoporosis. One case suffered a superficial incision infection postoperatively that healed with dressing change and effective antibiotic treatment. Bony fusion was obtained in all patients at the last follow-up, including 12 cases with grade I and 1 case with grade II, with a fusion rate of 92.31%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation is an effective, safe, and viable surgical procedure for the treatment of LBS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2022.1024510","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T01:24:35Z","timestamp":1672968275000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis"],"prefix":"10.3389","volume":"9","author":[{"given":"Xiangbin","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubin","family":"Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maiwulan","family":"Mansuerjiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikebaier","family":"Younusi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1016\/S1473-3099(07)70286-4","article-title":"Human brucellosis","volume":"7","author":"Franco","year":"2007","journal-title":"Lancet Infect Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1016\/j.spinee.2013.09.027","article-title":"Spinal brucellosis in south of Tunisia: review of 32 cases","volume":"14","author":"Koubaa","year":"2014","journal-title":"Spine J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"654","DOI":"10.3855\/jidc.2175","article-title":"Outcomes of treatment in 50 cases with spinal brucellosis in Babol, Northern Iran","volume":"6","author":"Smailnejad Gangi","year":"2012","journal-title":"J Infect Dev Ctries"},{"key":"B4","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1093\/clinids\/9.3.531","article-title":"Osteoarticular complications of brucellosis: a study of 169 cases","volume":"9","author":"Mousa","year":"1987","journal-title":"Rev Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1148\/radiographics.14.2.8190957","article-title":"Imaging features of musculoskeletal brucellosis","volume":"14","author":"al-Shahed","year":"1994","journal-title":"Radiographics"},{"key":"B6","doi-asserted-by":"publisher","first-page":"S12","DOI":"10.1016\/j.ijantimicag.2010.06.014","article-title":"Update on laboratory diagnosis of human brucellosis","volume":"36","author":"Araj","year":"2010","journal-title":"Int J Antimicrob Agents"},{"key":"B7","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1097\/01.blo.0000203455.59393.9a","article-title":"Surgical treatment of spinal brucellosis","volume":"444","author":"Katonis","year":"2006","journal-title":"Clin Orthop Relat Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e61840","DOI":"10.3791\/61840","article-title":"Diagnosis and surgical treatment of human brucellar spondylodiscitis","author":"Abulizi","year":"2021","journal-title":"J Vis Exp"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1007\/s00586-013-2701-0","article-title":"Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse","volume":"22","author":"Soliman","year":"2013","journal-title":"Eur Spine J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"334","DOI":"10.31616\/asj.2018.0210","article-title":"Biportal endoscopic spinal surgery for lumbar spinal stenosis","volume":"13","author":"Kim","year":"2019","journal-title":"Asian Spine J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"438","DOI":"10.21037\/jss.2020.03.08","article-title":"Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis","volume":"6","author":"Pao","year":"2020","journal-title":"J Spine Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e18231","DOI":"10.1097\/MD.0000000000018231","article-title":"Spinal epidural abscess successfully treated with biportal endoscopic spinal surgery","volume":"98","author":"Kang","year":"2019","journal-title":"Medicine"},{"key":"B13","doi-asserted-by":"publisher","first-page":"3000605221085405","DOI":"10.1177\/03000605221085405","article-title":"Salmonella spondylodiscitis and epidural abscess successfully treated with unilateral biportal endoscopic discectomy and debridement: a rare case report","volume":"50","author":"Hsu","year":"2022","journal-title":"J Int Med Res"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3021","DOI":"10.1007\/s00701-021-04820-4","article-title":"Biportal endoscopic debridement and percutaneous screw fixation technique for spinal tuberculosis: how I do it","volume":"163","author":"Kim","year":"2021","journal-title":"Acta Neurochir"},{"key":"B15","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.nic.2015.01.004","article-title":"Spinal brucellosis","volume":"25","author":"Tali","year":"2015","journal-title":"Neuroimaging Clin N Am"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1097\/00007632-199506020-00014","article-title":"Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects?","volume":"20","author":"Bridwell","year":"1995","journal-title":"Spine"},{"key":"B17","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1097\/QCO.0b013e3283638104","article-title":"Brucellosis in low-income and middle-income countries","volume":"26","author":"Rubach","year":"2013","journal-title":"Curr Opin Infect Dis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e469","DOI":"10.1016\/j.ijid.2009.06.031","article-title":"Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature","volume":"14","author":"Buzgan","year":"2010","journal-title":"Int J Infect Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e228","DOI":"10.1016\/j.ijid.2011.12.011","article-title":"Brucellosis in Turkey: an overview","volume":"16","author":"Yumuk","year":"2012","journal-title":"Int J Infect Dis"},{"key":"B20","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1136\/jnnp.51.6.803","article-title":"Stabilisation of the infected spine","volume":"51","author":"Redfern","year":"1988","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e11704","DOI":"10.1097\/MD.0000000000011704","article-title":"One-stage surgical management for lumber brucella spondylitis with anterior debridement, autogenous graft, and instrumentation","volume":"97","author":"Yin","year":"2018","journal-title":"Medicine"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1007\/s00264-009-0758-5","article-title":"One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation","volume":"33","author":"Huang","year":"2009","journal-title":"Int Orthop"},{"key":"B23","doi-asserted-by":"publisher","first-page":"S69","DOI":"10.1007\/s00590-014-1508-y","article-title":"Study on anterior and posterior approaches for spinal tuberculosis: a meta-analysis","volume":"25","author":"Muheremu","year":"2015","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s12891-016-0902-5","article-title":"Treatment of lumbosacral spinal tuberculosis by one-stage anterior debridement and fusion combined with dual screw-rod anterior instrumentation underneath the iliac vessel","volume":"17","author":"Zhang","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e192","DOI":"10.2106\/JBJS.L.01607","article-title":"Effect and possible mechanism of muscle-splitting approach on multifidus muscle injury and atrophy after posterior lumbar spine surgery","volume":"95","author":"Hu","year":"2013","journal-title":"J Bone Joint Surg Am"},{"key":"B26","doi-asserted-by":"publisher","first-page":"602","DOI":"10.3171\/2015.7.SPINE15304","article-title":"Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results","volume":"24","author":"Hwa Eum","year":"2016","journal-title":"J Neurosurg Spine"},{"key":"B27","doi-asserted-by":"publisher","first-page":"E8","DOI":"10.3171\/2017.5.FOCUS17146","article-title":"Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results","volume":"43","author":"Heo","year":"2017","journal-title":"Neurosurg Focus"},{"key":"B28","doi-asserted-by":"publisher","first-page":"863931","DOI":"10.3389\/fsurg.2022.863931","article-title":"Unilateral biportal endoscopic tumor removal and percutaneous stabilization for extradural tumors: technical case report and literature review","volume":"9","author":"Kim","year":"2022","journal-title":"Front Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"569","DOI":"10.4184\/asj.2018.12.3.569","article-title":"Biportal endoscopic spine surgery for various foraminal lesions at the lumbosacral lesion","volume":"12","author":"Choi","year":"2018","journal-title":"Asian Spine J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"E1112","DOI":"10.1097\/BRS.0000000000002093","article-title":"One-stage surgical management for lumbar brucella spondylitis by posterior debridement, autogenous bone graft and instrumentation: a case series of 24 patients","volume":"42","author":"Chen","year":"2017","journal-title":"Spine"},{"key":"B31","doi-asserted-by":"publisher","first-page":"3","DOI":"10.21767\/2471-8173.100043","article-title":"The surgical treatment of lumbar brucellar spondylitis by posterior approach","volume":"4","author":"Xining","year":"2018","journal-title":"Spine Res"},{"key":"B32","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s00264-019-04456-1","article-title":"Percutaneous endoscopic debridement with percutaneous pedicle screw fixation for lumbar pyogenic spondylodiscitis: a preliminary study","volume":"44","author":"Duan","year":"2020","journal-title":"Int Orthop"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e73","DOI":"10.1016\/j.wneu.2020.04.132","article-title":"Unilateral or bilateral percutaneous endoscopic debridement and lavage treatment for lumbar spinal tuberculosis","volume":"140","author":"Wu","year":"2020","journal-title":"World Neurosurg"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.1097\/00007632-199310000-00028","article-title":"Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study","volume":"18","author":"Oga","year":"1993","journal-title":"Spine"},{"key":"B35","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1002\/jor.1100120409","article-title":"Infection at the site of implanted materials with and without preadhered bacteria","volume":"12","author":"Chang","year":"1994","journal-title":"J Orthop Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"E7","DOI":"10.3171\/foc.2004.17.6.7","article-title":"Instrumentation in patients with spinal infection","volume":"17","author":"Lee","year":"2004","journal-title":"Neurosurg Focus"},{"key":"B37","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s00264-006-0140-9","article-title":"Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis","volume":"31","author":"Linhardt","year":"2007","journal-title":"Int Orthop"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e93648","DOI":"10.1371\/journal.pone.0093648","article-title":"The clinical outcomes of surgical treatment of noncontiguous spinal tuberculosis: a retrospective study in 23 cases","volume":"9","author":"Huang","year":"2014","journal-title":"PLoS One"},{"key":"B39","doi-asserted-by":"publisher","first-page":"106259","DOI":"10.1016\/j.clineuro.2020.106259","article-title":"Safety and efficacy of polyetheretherketone (PEEK) cages in combination with one-stage posterior debridement and instrumentation in lumbar brucella spondylitis","volume":"199","author":"Zhao","year":"2020","journal-title":"Clin Neurol Neurosurg"},{"key":"B40","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1080\/03007995.2017.1284050","article-title":"Titanium cages versus autogenous iliac crest bone grafts in anterior cervical discectomy and fusion treatment of patients with cervical degenerative diseases: a systematic review and meta-analysis","volume":"33","author":"Shao","year":"2017","journal-title":"Curr Med Res Opin"},{"key":"B41","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1055\/s-0035-1552985","article-title":"Iliac crest bone graft in lumbar fusion: the effectiveness and safety compared with local bone graft, and graft site morbidity comparing a single-incision midline approach with a two-incision traditional approach","volume":"5","author":"Fance","year":"2015","journal-title":"Global Spine J"},{"key":"B42","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1007\/s00586-008-0875-7","article-title":"Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study","volume":"18","author":"Putzier","year":"2009","journal-title":"Eur Spine J"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1621","DOI":"10.1007\/s00586-009-1036-3","article-title":"The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation","volume":"18","author":"Abbushi","year":"2009","journal-title":"Eur Spine J"},{"key":"B44","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1097\/01.brs.0000147801.63304.8a","article-title":"Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants","volume":"30","author":"Ha","year":"2005","journal-title":"Spine"},{"key":"B45","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s12893-017-0279-x","article-title":"Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis","volume":"17","author":"Abulizi","year":"2017","journal-title":"BMC Surg"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1007\/s00402-014-2016-6","article-title":"A comparative study between local bone graft with a cage and with no cage in single posterior lumbar interbody fusion (PLIF): a multicenter study","volume":"134","author":"Liu","year":"2014","journal-title":"Arch Orthop Trauma Surg"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1016\/j.nano.2017.01.011","article-title":"Layer-by-layer self-assembled multilayers on PEEK implants improve osseointegration in an osteoporosis rabbit model","volume":"13","author":"Liu","year":"2017","journal-title":"Nanomedicine"},{"key":"B48","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1016\/S0736-0266(01)00022-5","article-title":"Toxic effect of rifampicin on human osteoblast-like cells","volume":"19","author":"Isefuku","year":"2001","journal-title":"J Orthop Res"},{"key":"B49","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1302\/2046-3758.115","article-title":"Rifampicin restores extracellular organic matrix formation and mineralization of osteoblasts after intracellular Staphylococcus aureus infection","volume":"11","author":"Alagboso","year":"2022","journal-title":"Bone Joint Res"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.1024510\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T01:24:37Z","timestamp":1672968277000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.1024510\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,6]]},"references-count":49,"alternative-id":["10.3389\/fsurg.2022.1024510"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.1024510","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,6]]},"article-number":"1024510"}}