# Anterior cervical discectomy and fusion in treating acute myelopathy caused by Brucella cervical spondylitis: a case series

## TL;DR

This case series shows that anterior cervical discectomy and fusion (ACDF) can effectively treat acute spinal cord issues caused by Brucella infection, improving patient outcomes.

## Contribution

The study presents the first clinical evaluation of ACDF for acute myelopathy due to Brucella cervical spondylitis.

## Key findings

- ACDF improved neurological function in all six patients, with significant improvements in ASIA classifications.
- Pain and disability scores showed substantial postoperative improvement, with no recurrence observed.
- Bone fusion was achieved in all patients within a median of four months.

## Abstract

Cervical disease caused by Brucella infection is rare, with acute spinal cord impairment due to myelitis being a severe complication. If untreated, it can lead to significant patient damage. This study aims to begin to investigate the clinical characteristics of acute cervical myelitis caused by Brucella infection and to evaluate the profile of clinical benefit of anterior cervical discectomy and fusion (ACDF) for this condition.

This retrospective case series included 6 patients who underwent surgical treatment for acute cervical spinal cord impairment due to Brucella infection at our institution between January 1, 2013, and January 1, 2023. Clinical data such as age, gender, surgery duration, follow-up period, medication duration, time to bone fusion, ASIA classification, Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI) score were collected both preoperatively and postoperatively. Statistical analysis was used to assess the clinical benefits of ACDF surgery.

Six patients (4 males, 2 females) underwent successful ACDF. The median age was 52.5 years. The median surgery duration was 130.0 min, and the median hospital stay was 13.5 days. The median follow-up period was 15.0 months, and the median duration of postoperative medication was 16.0 weeks. All patients achieved satisfactory bone graft fusion, with a median fusion time of 4.0 months. ASIA classifications improved in all patients. Three patients improved from grade C to grade E, two from grade B to grades D and E, and one from grade C to grade D. The median VAS score decreased from 6.0 preoperatively to 0.0 at follow-up. The median JOA score increased from 6.0 to 17.0, and the NDI score improved from 29.5 to 4.5. No recurrence of infection or neurological symptoms was observed during follow-up.

Acute cervical spinal cord impairment from Brucella infection is rare and challenging to diagnose early. However, early ACDF application effectively relieved spinal cord compression, improved neurological symptoms, and enhanced patient outcomes, demonstrating its efficacy for treating acute myelitis caused by Brucella infection.