J Korean Neurosurg Soc.  2014 Jan;55(1):48-50. 10.3340/jkns.2014.55.1.48.

Collapsed L4 Vertebral Body Caused by Brucellosis

• Ekici MA
• Ozbek Z
• Kazanci B
• Guclu B

• KMID: 2191041
• DOI: http://doi.org/10.3340/jkns.2014.55.1.48

Abstract

Brucellosis is caused by gram-negative, aerobic, non-motile, facultative, intracellular coccobacilli belonging to the genus Brucella. A 50-year-old man working as an employee was admitted to neurosurgery clinic with severe low back, radicular right leg pain and hypoesthesia in right L4-5 dermatomes for 2 months. Brucella tube agglutination (Wright) test was positive in serum sample of the patient with a titer of 1/640. Brucella melitensis was isolated from blood culture. X-ray and MRI of the lomber spine showed massive collapse of L4 vertebral body. Neural tissue was decompressed and then posterior L3-5 short segment transpedicular screw fixation and stabilization was performed. Brucella melitensis was isolated from microbiologic culture of pathologic specimen. Antibiotic therapy was given as doxycycline 200 mg/day and rifampicin 600 mg/day for 6 months. Brucellosis is a systemic zoonotic infection and still an important public health problem in many geographical parts of the world. Vertebral body collapse caused by brucellosis occurs very rarely but represents a neurosurgical emergency because of its potential for causing rapidly progressive spinal cord compression and permanent paralysis. Neurosurgeons, emergency department personnel as well as infectious disease specialists should always keep a high index of suspicion and include brucellosis in the differential diagnosis of vertebral body collapse.

Keyword

Brucellosis; Spinal infections; Treatment; Vertebral collapse

MeSH Terms

Agglutination
Brucella
Brucella melitensis
Brucellosis*
Communicable Diseases
Diagnosis, Differential
Doxycycline
Emergencies
Emergency Service, Hospital
Humans
Hypesthesia
Leg
Magnetic Resonance Imaging
Middle Aged
Neurosurgery
Paralysis
Public Health
Rifampin
Specialization
Spinal Cord Compression
Spine
Zoonoses
Doxycycline
Rifampin

Figure

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  Fig. 1 A : Lateral spine X-ray of the patient showing collapsed L4 vertebral body (arrow). B and C : Saggital T2 and T1-weighted MRI of the lumbar spine showing collapsed L4 vertebral body and compression of neural elements (white arrow). D : Axial T2-weighted MRI of the lumbar spine showing collapsed L4 vertebral body compressing neural elements (black arrow showing neural tissue, white arrow showing collapsed vertebral body).

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  Fig. 2 Postoperative lateral (A) and AP X-ray (B) showing transpedicular screw fixation on the L3 and L5 vertebral body.

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