Collapsed L4 Vertebral Body Caused by Brucellosis
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. His past history revealed that he had weight loss, night sweats and chills, fatigue and severe malaise for 4 months, and he consumed unpaesteurized milk and dairy products. On neurological examination there was 3/5 motor strength of right ankle dorsiflexion and hypoesthesia in distribution of right leg L4-5 dermatomes. Brucellosis was common in the area where the patient was living and brucella tube agglutination (Wright) test was routinely studied in suspected patients coming from that area. Brucella tube agglutination (Wright) test was studied in serum sample of the patient and was positive with a titer of 1/640. Brucella melitensis was isolated from blood culture. X-ray of the lumber spine showed massive collapse of L4 vertebral body (). Magnetic resonance imaging (MRI) revealed fracture and collapse of the body of L4 vertebrae (). The spinal canal was narroved by posterior elements of the vertebrae, therefore neural tissue was compressed ().\nThe patient was taken to the operation emergently a posterior midline approach and bilateral hemilaminotomy were done. Grey-yellow colored pathologic specimen was obtained from vertebral body and epidural space. Neural tissue was decompressed and then posterior L3-5 short segment transpedicular screw fixation and stabilization was performed (). Tricortical iliac crest wedge obtained from the same patient (autograft) was used for fusion. Neurological signs and symtoms of the patient were recovered after the operation. Brucella melitensis was isolated from microbiologic culture of pathologic specimen. Antibiotic therapy was given for brucellar infection as doxycycline 200 mg/day and rifampicin 600 mg/day for 6 months.