Analysis of Risk Factors for Postoperative Complications of Thoracolumbar Brucella Spondylitis 

Analysis of Risk Factors for Postoperative Complications of Thoracolumbar Brucella Spondylitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of Risk Factors for Postoperative Complications of Thoracolumbar Brucella Spondylitis Yao Zhang, Changsong Zhao, Jiamin Chen, Qiang Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8435058/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background This study aimed to identify risk factors for postoperative complications following a one-stage posterior approach for thoracolumbar Brucellosis spondylitis. Methods We retrospectively analyzed data from 61 patients with thoracolumbar Brucellosis spondylitis who underwent a one-stage posterior approach at this institution between January 2015 and January 2019. To compare clinical characteristics, patients were divided into two groups based on the presence of postoperative complications: a complication group (14 cases) and a control group (47 cases). Logistic regression analysis was then used to identify factors associated with postoperative complications. Results Disease duration, fever status, and hemoglobin levels differed significantly between groups (all P < 0.05). Further, multivariate analysis identified diabetes, fever, and psoas muscle abscess as independent risk factors for postoperative complications (all P < 0.05). Conclusion Having diabetes, fever, and psoas muscle abscess are independent risk factors for complications after a one-stage posterior approach for thoracolumbar Brucellosis spondylitis. Therefore, careful selection of surgical indications, strict surgical technique, proper blood glucose management in diabetic patients, and preoperative control of body temperature are essential to reduce complication rates. Thoracolumbar spine Brucellosis spondylitis Postoperative complications Risk factors Figures Figure 1 Figure 2 Introduction Brucellosis is a zoonotic disease caused by Brucella species, with animals as the source of infection [ 1 , 2 ]. In China, brucellosis cases are mainly found in northern regions, such as Inner Mongolia [ 3 , 4 ]. The primary cause of human brucellosis is contact with livestock, such as cattle and sheep infected with Brucella, as well as their dairy and meat products. Brucella enters the body through the respiratory, skin, and digestive tracts, leading to fever and damage to multiple organs. Over time, the affected areas have shifted from localized to more scattered regions. Clinically, the most common symptom is lesions in the bone-joint and muscle systems, mainly affecting large joints, with the spine as the most frequently involved site. Brucellar spondylitis, caused by Brucella invading the spine, has an incidence of up to 60% in patients with brucellosis [ 5 , 6 ]. Among these cases, the lumbar spine is most commonly affected, followed by the thoracic and, less commonly, the cervical spine. Current treatments for brucellar spondylitis are drug therapy and surgery [ 2 , 7 ]. Surgery is required when thoracolumbar pain persists or worsens after conservative care, when spinal nerves are compressed, or when spinal stability is compromised [ 8 – 10 ]. However, surgery for brucellar spondylitis is challenging, with a high rate of complications and recurrence. Issues such as unclean incisions can result in poor wound healing and sinus tract formation, which may necessitate revision and debridement. Moreover, rates of wound infection and non-healing are reported to be higher than in other spinal surgeries [ 11 , 12 ]. Despite these challenges, few studies have examined the risk factors for postoperative complications following surgical treatment of brucellar spondylitis. This study analyzed such risk factors and aimed to provide a reference for reducing the probability of these complications. Materials and methods Patient population From January 2015 to January 2019, 212 patients with brucellar spondylitis were admitted to our department. Of these, 142 were discharged after improvement with conservative treatment, and 70 patients showed little or no relief after anti-brucellosis drug therapy and underwent surgery. Among them, 61 had thoracolumbar brucellar spondylitis, all of whom were treated with one-stage posterior debridement, decompression, internal fixation, and interbody bone graft fusion (Fig. 1). Inclusion criteria were as follows: 1. fulfillment of the diagnostic criteria for brucellosis spondylitis [ 5 , 13 ], completion of laboratory tests, X-ray, CT, and MRI examinations prior to surgery, and pathological confirmation of thoracolumbar brucellosis spondylitis during the operation; 2. fulfillment of the surgical indications for brucellosis spondylitis [ 5 , 10 ]; 3. absence of a history of spinal trauma; 4. adulthood without developmental spinal deformities; 5. absence of other etiological findings, such as Mycobacterium tuberculosis, Staphylococcus aureus, or fungi; and 6. availability of complete follow-up clinical imaging and laboratory examination data. This retrospective study was approved by the ethical committee and performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. All patients in this study voluntarily signed an informed consent form to join the scientific research and signed an informed consent form for surgical treatment. Data collection Postoperative complications, such as incision infection, impaired wound healing, and recurrence, were systematically recorded. The following variables were collected: patient age and gender at the time of surgery, preoperative clinical symptoms such as fever and lower-limb manifestations, imaging findings including intraspinal, paravertebral, and psoas abscesses, and laboratory indicators such as white blood cell count, lymphocyte count, hemoglobin, erythrocyte sedimentation rate, C-reactive protein, albumin, and globulin. Preoperative conditions, including anemia, malnutrition, and underlying diseases such as diabetes, were documented. The surgical segment, operative time, and intraoperative blood loss were recorded. Preoperative preparation All 61 patients underwent preoperative anti-Brucellosis drug therapy using either a triple or a quadruple regimen [ 2 , 7 ]: doxycycline 200 mg/d, rifampicin 600 mg/d, and levofloxacin 500 mg/d. Ceftriaxone sodium 2 g/d was included based on individual patient conditions. Each treatment course lasted 6 weeks, with a total of 2 to 3 courses administered. Throughout therapy, regular assessments of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), liver function, and renal function were conducted. Thoracolumbar braces were used to ensure immobilization and protection during the anti-brucellosis drug therapy. Surgical techniques The patient is placed in the prone position. Vertebral pedicles are identified and marked using C-arm fluoroscopy. A posterior midline incision is made, followed by sequential incisions through the skin, subcutaneous tissue, and fascial layer. Bilateral dissection along the spinous processes is performed until the lamina and facet joints are exposed. Under fluoroscopic guidance, a positioning needle is used to localize the pedicle, after which a pedicle screw system is inserted. For selected thoracic vertebrae, screw insertion is assisted by a computer navigation system. Unilateral or bilateral fenestration and decompression are then performed. With direct visualization and the use of a discectomy endoscope, inflammatory tissues and damaged bone within the spinal canal, intervertebral space, and paravertebral area are thoroughly removed. The intervertebral space is cleared until fresh blood is observed, and the area is repeatedly irrigated using an irrigation gun. Crushed autologous bone is implanted into the intervertebral bone defect, and an intervertebral fusion cage is inserted obliquely. Compression is applied, and fixation is tightened. The area is irrigated again with the irrigation gun. After confirming hemostasis, a drainage tube is routinely placed, and the incision is sutured in layers. The lesion tissue obtained during the procedure is sent for pathological examination (Fig. 2). Postoperative Management Supportive care, including enhanced nutrition, should be administered following surgery. The drainage tube is to be removed within 2 to 3 days, contingent upon drainage status. Patients should wear a thoracolumbar brace and begin ambulation as tolerated. For the first three months, activity should be minimized, and bed rest prioritized. Postoperative anti-brucellosis pharmacotherapy must be continued. Statistical analysis All statistical analyses were performed using the SPSS software (version 25.0; IBM SPSS, New York). Continuous variables were presented as mean ± standard deviation or medians with interquartile ranges, while categorical variables were presented as the frequencies or percentages of events. The Mann-Whitney U test was used for non-normally distributed continuous variables, and a t-test was used for normally distributed continuous variables. Variables with P < 0.05 in univariate logistic regression were included in the multivariate model to identify risk factors for complications. Relative risks and corresponding 95% confidence intervals were calculated. Statistical significance was defined as α = 0.05 (two-sided). Results Comparison of clinical data between the two groups A total of 61 patients were enrolled and categorized into a complication group or a control group based on the presence or absence of postoperative complications (Table 1 ). Table 1 Comparison of clinical characteristic data between the complication group and the control group Characteristic complication group (n = 14) complication group (n = 47) P t Age(year) 60.07 ± 12.71 55.40 ± 7.26 0.194 -1.358 Sex(male/female) 11/3 33/14 0.785 0.074 Diabetes 7/7 12/35 0.160 1.978 Disease duration(d) 135(90,245) 90(60,180) 0.041 -1.875 Fever 9/5 16/31 0.043 4.079 Lower limb symptoms 6/8 24/23 0.590 0.291 Intraspinal abscess 9/5 20/27 0.153 2.043 Paravertebral abscess 11/3 31/16 0.571 0.320 Psoas muscle abscesses 6/8 11/36 0.114 2.501 Albumin level(g/L) 37.84 ± 3.37 38.09 ± 4.11 0.836 -0.208 Globulin level(g/L) 32.40 ± 4.63 29.94 ± 4.77 0.094 1.703 White blood cell count(x10 9 /L) 6.36 ± 2.15 5.38 ± 1.83 0.098 1.683 Lymphocyte count(x10 9 /L) 1.61(1.38,2.08) 1.81(1.34,2.32) 0.512 0.655 Hemoglobin level (g/L) 118.64 ± 17.84 131.11 ± 12.51 0.026 -2.441 Surgical segment 2.0(1.0, 2.25) 2.0(1.0, 3.0) 0.294 1.050 Operation time(h) 3.0(2.88, 325) 3.0(2.8, 3.5) 0.908 0.116 Blood loss(ml) 370(300, 400) 380(300, 400) 0.683 0.409 The complication group comprised 14 patients, with 12 cases of delayed wound healing and 2 cases of recurrence. Of these patients, 11 were male, and 3 were female. Ages ranged from 26 to 68 years, with a mean age of 60.07 ± 12.71 years. Seven patients had comorbid diabetes. Disease duration ranged from 30 to 260 days, with a median of 135 (90, 245) days. Clinical symptoms included fever in 9 patients and lower-limb symptoms in 6 patients. Imaging revealed intraspinal abscesses in 9 patients, paravertebral abscesses in 11 patients, and psoas abscesses in 6 patients. The control group included 47 patients, of whom 33 were male and 14 were female. Ages ranged from 38 to 72 years, with a mean age of 55.40 ± 7.26 years. Twelve patients had comorbid diabetes. Disease duration ranged from 30 to 720 days, with a median of 90 (60, 180) days. Clinical symptoms included fever in 16 patients and lower-limb symptoms in 24 patients. Imaging revealed intraspinal abscesses in 20 patients, paravertebral abscesses in 31 patients, and psoas abscesses in 11 patients. There were statistically significant differences between the two patient groups in disease duration, fever status, and hemoglobin levels (all P < 0.05; Table 1 ). In contrast, no statistically significant differences were observed between the two groups for the following variables: age, gender, diabetes mellitus, lower-limb symptoms, intraspinal abscess, paravertebral abscess, psoas abscess, white blood cell count, lymphocyte count, hemoglobin level, albumin level, globulin level, surgical segment, operation time, and blood loss (all P > 0.05; Table 1 ). Risk factors of postoperative complications Univariate analysis: Variables such as age, gender, disease duration, comorbid diabetes, comorbid intraspinal abscess, paravertebral abscess, psoas major muscle abscess, surgical segments, operation time, blood loss, white blood cell count, lymphocyte count, hemoglobin, albumin, globulin, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were initially identified based on their potential clinical relevance as risk factors for postoperative complications in patients with thoracolumbar Brucella spondylitis. These variables were subsequently included in the logistic regression analysis. Statistically significant factors were diabetes ( P = 0.040), fever ( P = 0.050), ESR ( P = 0.018), CRP ( P = 0.046), hemoglobin (HB) ( P = 0.010), and psoas major muscle abscess ( P = 0.042) (Table 2 ). Multivariate logistic regression: Six indicators—diabetes, fever, ESR, CRP, HB, and psoas major muscle abscess—were identified in the univariate logistic analysis and included as independent variables in the multivariate model using the full-model regression method. Regression results: Diabetes, fever, and psoas major muscle abscess were significant predictors of postoperative complications in patients with thoracolumbar Brucella spondylitis (Table 3 ). Table 2 Univariate logistic regression analysis of postoperative complications Factor B SE Wald χ2 P OR OR 95% CI Age -0.060 0.035 2.980 0.084 1.062 0.992 ~ 1.138 Sex -0.442 0.725 0.371 0.542 0.643 0.155 ~ 2.663 Disease duration -0.002 0.003 0.689 0.406 0.998 0.993 ~ 1.003 Surgical segment 0.417 0.399 1.091 0.296 1.517 0.694 ~ 3.314 Operation time 0.159 0.598 0.071 0.791 1.172 0.363 ~ 3.781 Blood loss 0.001 0.003 0.230 0.632 1.001 0.996 ~ 1.007 ESR -0.028 0.012 5.577 0.018 0.972 0.950 ~ 0.995 CRP -0.040 0.020 3.978 0.046 0.961 0.924 ~ 0.999 Albumin level 0.016 0.078 0.045 0.833 1.017 0.872 ~ 1.185 Globulin level -0.109 0.066 2.730 0.098 0.896 0.787 ~ 1.021 White blood cell count -0.246 0.153 2.576 0.109 0.782 0.579 ~ 1.056 Lymphocyte count 0.053 0.470 0.013 0.911 1.054 0.419 ~ 2.649 Hemoglobin level 0.061 0.023 6.657 0.010 1.063 1.015 ~ 1.113 Diabetes -1.070 0.631 2.882 0.040 0.343 0.100 ~ 1.180 Fever -1.249 0.637 3.845 0.050 0.287 0.082 ~ 0.999 Intraspinal abscess -0.888 0.631 1.980 0.159 0.412 0.119 ~ 1.417 Paravertebral abscess -0.638 0.720 0.784 0.376 0.528 0.129 ~ 2.169 Psoas muscle abscesses -1.186 0.636 3.476 0.042 0.306 0.088 ~ 1.063 Table 3 Multivariate Logistic Regression Analysis of Postoperative Complications Factor B S E Wald χ2 P OR OR 95% CI ESR -0.033 0.048 0.462 0.496 0.968 0.881 ~ 1.063 CRP 0.027 0.05 0.285 0.594 1.027 0.931 ~ 1.134 Hemoglobin level -0.086 0.063 1.875 0.171 0.917 0.811 ~ 1.038 Diabetes -2.166 1.106 3.834 0.050 0.115 0.013 ~ 1.002 Fever -0.127 1.007 0.016 0.039 0.881 0.122 ~ 6.344 Psoas muscle abscesses -1.83 1.104 2.744 0.048 0.16 0.018 ~ 1.398 Discussion Brucellar spondylitis is caused by Brucella infecting the spine. Current treatments are mainly drugs or surgery. Surgery is necessary when drugs do not relieve symptoms, when there are large paravertebral or psoas abscesses, or when vertebrae are unstable. Because incisions are contaminated and patients' immune systems are weak, wound healing is often poor, and the risks of infection and recurrence are higher. This study found that diabetes, fever, and psoas muscle abscess independently increase the risk of postoperative complications in thoracolumbar brucellar spondylitis and should be addressed during perioperative management. The relationship between diabetes and postoperative complications Diabetes is the most prevalent endocrine disorder worldwide, with China reporting the highest number of diabetic patients [ 14 , 15 ]. Previous studies have identified diabetes as an independent risk factor for postoperative wound infection following spinal surgery [ 16 – 18 ]. The co-occurrence of brucellar spondylitis and diabetes necessitates the simultaneous management of a specific infection and a complex systemic metabolic disorder. These conditions can interact, substantially increasing the complexity and risk associated with diagnosis and treatment. Diabetes impairs leukocyte function and causes circulatory disorders, thereby reducing the body's ability to eliminate Brucella and complicating infection control. Additionally, diabetic patients often exhibit a chronic low-grade inflammatory state. Following Brucella infection, these patients may experience a heightened inflammatory response, resulting in more severe and extensive bone destruction, an increased risk of abscess formation—particularly paravertebral or psoas abscesses that are difficult to resolve—and a greater likelihood of nerve damage due to inflammation and abscesses compressing the spinal cord or nerve roots. In this study, 50.00% (7/14) of patients in the complication group had diabetes. In patients with both brucellar spondylitis and diabetes, the use of hypoglycemic drugs can cause subcutaneous fat thickening. Intraoperative traction may damage this fat, leading to fat liquefaction, poor wound healing, or infection. Diabetic patients are also prone to microvascular lesions. The use of electrocoagulation during surgery may damage blood vessels, resulting in ischemia and hypoxia of the incision tissue, which can further contribute to poor wound healing or infection [ 12 ]. Furthermore, hyperglycemia in diabetic patients can reduce the synthesis of substances such as collagen fibers that promote wound healing, leading to delayed postoperative recovery. Currently, there is a paucity of studies, both domestically and internationally, that examine brucellosis complicated by diabetes. Yumuk Z [ 19 ] and colleagues infected diabetic rats with Brucella and observed a worsening of their condition following infection. Additionally, Widdrington JD [ 20 ] and colleagues identified diabetes as a risk factor for mortality in spondylitis in a large-scale retrospective study. For patients with brucellar spondylitis complicated by diabetes, it is essential to maintain strict blood glucose control during the perioperative period. Timely adjustment of the hypoglycemic regimen is recommended to minimize the risk of complications. The relationship between fever and postoperative complications In brucellosis spondylitis, fever often occurs in the afternoon, typically exceeding 38°C, and is accompanied by profuse sweating [ 2 , 10 ]. In this study, 64.29% (9/14) of patients in the complication group had concurrent fever. During the febrile period, a large number of bacteria are present in the vertebral lesions, and tissues are in a state of acute or sub-acute suppurative inflammation and edema, with abundant blood supply but fragile structure. Although the lesion is located in the spine, fever indicates bacteria may enter the bloodstream, posing a risk of bacteremia or septicemia, and the immune system is under stress [ 21 – 24 ]. If the fever is not controlled before surgery, many viable bacteria remain in the surgical area. Although most lesions are removed during surgery, remaining bacteria may proliferate due to low post-operative immunity or local hematoma, leading to poor wound healing or recurrence. This study identifies preoperative active fever as an independent risk factor for postoperative complications in brucellosis spondylitis. Nonhealing of the surgical wound and recurrence are linked to this risk. Control fever and stabilize the disease before elective surgery to reduce complications. The relationship between psoas major muscle abscess and postoperative complications Following spinal invasion by Brucella, granulomas proliferate beneath the cartilaginous endplate. Disease progression results in expansion of the affected area, bone destruction, and narrowing of the intervertebral space. Rupture of paravertebral lymph nodes may lead to paravertebral or psoas muscle abscesses [ 2 , 25 , 26 ]. Esmaeilnejad-Ganji SM [ 27 ] and colleagues reported that thoracolumbar pain in brucellar spondylitis is associated with epidural, paravertebral, and psoas muscle abscesses. Clinical outcomes remain poor in the presence of abscesses, even with rigorous treatment. Yang B [ 28 ] and others observed that, compared to spinal tuberculosis, brucellar spondylitis is characterized by bone destruction with concurrent bone hyperplasia, and abscesses are typically limited to the vicinity of the affected vertebral bodies. Ulu-Kilic A [ 29 ] and colleagues analyzed clinical data from 293 patients with brucellar spondylitis and identified psoas muscle abscesses in only 10 cases, indicating a relatively low incidence. They concluded that psoas muscle abscesses are uncommon in brucellar spondylitis. In the present study, 42.85% (6/14) of patients in the complication group exhibited psoas muscle abscesses. Compared to spinal tuberculosis, brucellar spondylitis is associated with fewer cases of psoas muscle abscesses. Consequently, inadequate perioperative attention and incomplete debridement of psoas muscle abscesses during surgery may increase the risk of postoperative complications. This study utilized the posterior surgical approach. Traditionally, brucellar spondylitis has been managed with a combined anterior-posterior approach, which is associated with significant surgical trauma, increased procedural risks, greater demands for spinal stability reconstruction, occasional insufficient fixation strength, the need for intraoperative repositioning, and higher physical requirements for patients [ 30 – 32 ]. In recent years, the posterior approach has gained preference among surgeons, as it mitigates these disadvantages and can significantly reduce recurrence rates [ 33 , 34 ]. Although multiple studies have demonstrated that posterior surgery for brucellar spondylitis yields satisfactory clinical outcomes, REN HL [ 35 ] and colleagues identified limitations of the posterior approach, including a restricted visual field. This limitation is particularly problematic in cases with paravertebral or psoas abscesses, where complete lesion removal is challenging and may compromise surgical efficacy. Therefore, in clinical management of brucellar spondylitis complicated by psoas muscle abscesses, careful preoperative assessment, meticulous surgical planning, and strict adherence to operative protocols are essential to minimize postoperative complications. Conclusion In conclusion, diabetes, fever, and psoas abscess are significant risk factors for postoperative complications in patients with thoracolumbar Brucella spondylitis. To reduce these complications, surgical indications should be selected judiciously, surgical procedures must be rigorously followed, blood glucose in diabetic patients should be controlled, and preoperative body temperature must be managed appropriately. Due to the study's limitations, including a small sample size and absence of multicenter data, future research should focus on larger, collaborative studies to validate and extend these findings. Health professionals should implement these recommendations and support broader clinical investigations. Abbreviations ESR erythrocyte sedimentation rate CRP C-reactive protein CT computed tomography MRI magnetic resonance imaging Declarations Ethics approval and consent to participate This retrospective study was approved by the ethical committee of Beijing Ditan Hospital, Capital Medical University and performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. And all participants signed informed consent for publication. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding None. Author Contribution YZ and CSZ conceived the manuscript, participated in the collection of clinical data and manuscript writing; YZ and JMC participated in the pathological examination, YZ and QZ participated in the manuscript revision. All authors read and approved the final manuscript. Acknowledgements The authors thank the participants for making this study possible and the Department of Pathology for technical support. Data Availability The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. References Chen J, Zhi F, Zhao G, Su M, Geng H, Song W, Chu Y, Zhang H. Brucella osteoarthritis: recent progress and future directions. Front Microbiol. 2025;16:1522537. 10.3389/fmicb.2025.1522537 . Ali Adam A, Sheikh Hassan M, Adam Osman A. Spinal brucellosis causing spondylodiscitis. Ann Med Surg (Lond). 2022;82:104782. 10.1016/j.amsu.2022.104782 . Liu Z, Shi Y, Xue C, Yuan M, Li Z, Zheng C. Epidemiological and Spatiotemporal Clustering Analysis of Human Brucellosis - China, 2019–2023. China CDC Wkly. 2025;7(4):130–6. 10.46234/ccdcw2025.020 . He K, Xing W. Efficacy of spinal fusion in Brucella spondylitis: a systematic review. Front Surg. 2025;12:1537153. 10.3389/fsurg.2025.1537153 . Jin M, Fan Z, Gao R, Li X, Gao Z, Wang Z. Research progress on complications of B rucellosis. Front Cell Infect Microbiol. 2023;13:1136674. 10.3389/fcimb.2023.1136674 . Deng Y, Liu X, Duan K, Peng Q. Res Progress Brucellosis Curr Med Chem. 2019;26(30):5598–608. 10.2174/0929867325666180510125009 . Chan AK, Sharma V, Robinson LC, Mummaneni PV. Summary of Guidelines for the Treatment of Lumbar Spondylolisthesis. Neurosurg Clin N Am. 2019;30(3):353–64. 10.1016/j.nec.2019.02.009 . Spernovasilis N, Karantanas A, Markaki I, Konsoula A, Ntontis Z, Koutserimpas C, Alpantaki K. Brucella Spondylitis: Current Knowledge and Recent Advances. J Clin Med. 2024;13(2):595. 10.3390/jcm13020595 . Feng Z, Wang X, Yin X, Han J, Tang W. Analysis of the Curative Effect of Posterior Approach on Lumbar Brucellar Spondylitis with Abscess through Magnetic Resonance Imaging under Improved Watershed Algorithm. Contrast Media Mol Imaging. 2021;2021:1933706. 10.1155/2021/1933706 . Luan H, Liu K, Deng X, Sheng W, Mamat M, Guo H, Li H, Deng Q. One-stage posterior surgery combined with anti-Brucella therapy in the management of lumbosacral brucellosis spondylitis: a retrospective study. BMC Surg. 2022;22(1):394. 10.1186/s12893-022-01847-x . Lee CC, Chen CW, Yen HK, Lin YP, Lai CY, Wang JL, Groot OQ, Janssen SJ, Schwab JH, Hsu FM, Lin WH. Comparison of Two Modern Survival Prediction Tools, SORG-MLA and METSSS, in Patients With Symptomatic Long-bone Metastases Who Underwent Local Treatment With Surgery Followed by Radiotherapy and With Radiotherapy Alone. Clin Orthop Relat Res. 2024;482(12):2193–208. 10.1097/CORR.0000000000003185 . Pan S, Chen S, Zhou K, Wu J, Wu C, Tuerxun M, Chong Y, Zhu J. Development and validation of a clinico-biological score for Brucella spondylitis: a two-center study. BMC Infect Dis. 2025;25(1):1445. 10.1186/s12879-025-11886-3 . Zhang Y, Zhao C, Chen J, Zhang Q. Beneficial influence of single-stage posterior surgery for the treatment of lumbar brucella spondylitis combined with spondylolisthesis. Sci Rep. 2022;12(1):19459. 10.1038/s41598-022-24223-4 . Yang SH, Dou KF, Song WJ. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362(25):2425–6. author reply 2426. Xu Y, Lu J, Li M, Wang T, Wang K, Cao Q, Ding Y, Xiang Y, Wang S, Yang Q, Zhao X, Zhang X, Xu M, Wang W, Bi Y, Ning G. Diabetes in China part 2: prevention, challenges, and progress. Lancet Public Health. 2024;9(12):e1098–104. 10.1016/S2468-2667(24)00251-2 . Xavier LFD, Medeiros AS, Melo MCSF, Santos RNG, Gama ZADS, Freitas MR. Improvement project to reduce surgical site infections: a retrospective cohort study. Rev Col Bras Cir. 2023;50:e20233380. 10.1590/0100-6991e-20233380-en . Zhang X, Liu P, You J. Risk factors for surgical site infection following spinal surgery: A meta-analysis. Med (Baltim). 2022;101(8):e28836. 10.1097/MD.0000000000028836 . Saruwatari R, Yamada K, Sato K, Yokosuka K, Yoshida T, Nakae I, Shimazaki T, Morito S, Shiba N. Risk Factors for Surgical Site Infection in Spinal Surgery and Interventions: A Retrospective Study. Kurume Med J. 2023;68(34):201–7. 10.2739/kurumemedj.MS6834004 . Yumuk Z, Küçükbasmaci O, Büyükbaba Boral O, Küçüker Anğ M, Dundar V. The effects of streptozotocin-induced diabetes on brucellosis of rats. FEMS Immunol Med Microbiol. 2003;39(3):275–8. 10.1016/S0928-8244(03)00257-8 . Widdrington JD, Emmerson I, Cullinan M, Narayanan M, Klejnow E, Watson A, Ong ELC, Schmid ML, Price DA, Schwab U, Duncan CJA. Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice. Med Sci (Basel). 2018;6(4):96. 10.3390/medsci6040096 . Wu ZG, Song ZY, Wang WX, Xi WN, Jin D, Ai MX, Wu YC, Lan Y, Song SF, Zhang GC, Yao XB, Gao Z, Liu CY, Sun K, Yu DS, Xie BG, Sun SL. Human brucellosis and fever of unknown origin. BMC Infect Dis. 2022;22(1):868. 10.1186/s12879-022-07872-8 . Wu ZG, Song ZY, Wang WX, Xi WN, Jin D, Ai MX, Wu YC, Lan Y, Song SF, Zhang GC, Yao XB, Gao Z, Liu CY, Sun K, Yu DS, Xie BG, Sun SL. Correction: Human brucellosis and fever of unknown origin. BMC Infect Dis. 2023;23(1):23. 10.1186/s12879-023-07986-7 . Burns RJL, Le KK, Siengsanun-Lamont J, Blacksell SD. A review of coxiellosis (Q fever) and brucellosis in goats and humans: Implications for disease control in smallholder farming systems in Southeast Asia. One Health. 2023;16:100568. 10.1016/j.onehlt.2023.100568 . Hayoun MA, Muco E, Shorman M, Brucellosis. 2023 Apr 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Zhang T, Ma L, Liu H, Zhang L, Yang C, Li S. Clinical characteristic, management, and outcomes of cervical spinal brucellosis: a retrospective cohort study over 1-year postoperative follow-up. J Orthop Surg Res. 2024;19(1):378. 10.1186/s13018-024-04868-9 . Gao S, Hu Y, Mamat F, Xun C, Li H, Liang W, Cai X, Sheng W. Anterior debridement, reconstruction, and fusion for cervical brucellosis spondylitis with epidural abscess: a single-center experience of 30 patients. Eur Spine J. 2025;34(10):4680–8. 10.1007/s00586-025-09038-x . Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: A review. World J Orthop. 2019;10(2):54–62. 10.5312/wjo.v10.i2.54 . Yang B, Hu H, Chen J, He X, Li H. The Evaluation of the Clinical, Laboratory, and Radiological Findings of 16 Cases of Brucellar Spondylitis. Biomed Res Int. 2016;2016:8903635. 10.1155/2016/8903635 . Ulu-Kilic A, Karakas A, Erdem H, Turker T, Inal AS, Ak O, Turan H, Kazak E, Inan A, Duygu F, Demiraslan H, Kader C, Sener A, Dayan S, Deveci O, Tekin R, Saltoglu N, Aydın M, Horasan ES, Gul HC, Ceylan B, Kadanalı A, Karabay O, Karagoz G, Kayabas U, Turhan V, Engin D, Gulsun S, Elaldı N, Alabay S. Update on treatment options for spinal brucellosis. Clin Microbiol Infect. 2014;20(2):O75–82. 10.1111/1469-0691.12351 . Jiang D, Ma L, Wang X, Xu Z, Sun G, Jia R, Wu Y, Zhang Y. Comparison of two surgical interventions for lumbar brucella spondylitis in adults: a retrospective analysis. Sci Rep. 2023;13(1):16684. 10.1038/s41598-023-43812-5 . Yin XH, Liu ZK, He BR, Hao DJ. One-stage surgical management for lumber brucella spondylitis with anterior debridement, autogenous graft, and instrumentation. Med (Baltim). 2018;97(30):e11704. 10.1097/MD.0000000000011704 . Liu C, Liu Q, Zheng J, Niu N, Shi J, Yang Z. Selection of treatment strategies for lumbar Brucella spondylitis: a retrospective clinical study. Front Surg. 2024;11:1365498. 10.3389/fsurg.2024.1365498 . Yang Y, Ma X. Clinical efficacy analysis of one-stage posterior debridement, bone graft fusion, and internal fixation for the treatment of lumbar brucellosis spondylitis. BMC Surg. 2025;25(1):391. 10.1186/s12893-025-03143-w . Guo Y, Yang Y, Chen Z, Feng D, Lei F. One-stage posterior debridement approach combined with autogenous bone grafting and internal fixation for the treatment of adult thoracic or lumbar suppurative spondylitis via the multifidus and longissimus interspaces. J Orthop Surg Res. 2025;20(1):330. 10.1186/s13018-025-05735-x . Ren HL, Jiang JM, Wang JX, Qu DB, Chen JT. Is duration of preoperative anti-tuberculosis treatment a risk factor for postoperative relapse or non-healing of spinal tuberculosis? Eur Spine J. 2016;25(12):3875–83. 10.1007/s00586-016-4496-2 . Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":1544119,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart showing study enrollment.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8435058/v1/cce51db9e82686ed32ac7922.png"},{"id":100123647,"identity":"71ceaa50-76b9-4eeb-a170-9800d5e04a21","added_by":"auto","created_at":"2026-01-13 09:09:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2628247,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eImaging manifestations of a typical patient before and after surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea-b \u003c/strong\u003ePre-operative X-rays demonstrate lumbar scoliosis, kyphotic deformity, and reduced intervertebral space between the first and second lumbar vertebrae. \u003cstrong\u003ec-d \u003c/strong\u003ePre-operative CT scans identify multiple foci of destruction at the superior and inferior margins of the first and second lumbar vertebral bodies. \u003cstrong\u003ee-h\u003c/strong\u003ePre-operative MRI scans indicate inhomogeneous and abnormal signal changes in the vertebral bodies and intervertebral discs, as well as the presence of intraspinal and paravertebral abscesses. \u003cstrong\u003ei-j \u003c/strong\u003ePostoperative X-rays obtained two days after surgery demonstrate correction of scoliosis and restoration of intervertebral space height between the first and second lumbar vertebrae. \u003cstrong\u003ek-l \u003c/strong\u003eCT scans performed one year postoperatively confirm bony fusion between the vertebrae and substantial repair of previously damaged areas.\u003c/p\u003e","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-8435058/v1/557ee232d1a345760c86d5c6.png"},{"id":100382014,"identity":"f493bb32-31f4-40f6-b74d-69295eda4712","added_by":"auto","created_at":"2026-01-16 10:40:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":7170462,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8435058/v1/fe3206fa-74fa-4d97-893d-368bf1eddc33.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of Risk Factors for Postoperative Complications of Thoracolumbar Brucella Spondylitis ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBrucellosis is a zoonotic disease caused by Brucella species, with animals as the source of infection [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In China, brucellosis cases are mainly found in northern regions, such as Inner Mongolia [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The primary cause of human brucellosis is contact with livestock, such as cattle and sheep infected with Brucella, as well as their dairy and meat products. Brucella enters the body through the respiratory, skin, and digestive tracts, leading to fever and damage to multiple organs. Over time, the affected areas have shifted from localized to more scattered regions. Clinically, the most common symptom is lesions in the bone-joint and muscle systems, mainly affecting large joints, with the spine as the most frequently involved site. Brucellar spondylitis, caused by Brucella invading the spine, has an incidence of up to 60% in patients with brucellosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Among these cases, the lumbar spine is most commonly affected, followed by the thoracic and, less commonly, the cervical spine.\u003c/p\u003e \u003cp\u003eCurrent treatments for brucellar spondylitis are drug therapy and surgery [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Surgery is required when thoracolumbar pain persists or worsens after conservative care, when spinal nerves are compressed, or when spinal stability is compromised [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, surgery for brucellar spondylitis is challenging, with a high rate of complications and recurrence. Issues such as unclean incisions can result in poor wound healing and sinus tract formation, which may necessitate revision and debridement. Moreover, rates of wound infection and non-healing are reported to be higher than in other spinal surgeries [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these challenges, few studies have examined the risk factors for postoperative complications following surgical treatment of brucellar spondylitis. This study analyzed such risk factors and aimed to provide a reference for reducing the probability of these complications.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient population\u003c/h2\u003e \u003cp\u003eFrom January 2015 to January 2019, 212 patients with brucellar spondylitis were admitted to our department. Of these, 142 were discharged after improvement with conservative treatment, and 70 patients showed little or no relief after anti-brucellosis drug therapy and underwent surgery. Among them, 61 had thoracolumbar brucellar spondylitis, all of whom were treated with one-stage posterior debridement, decompression, internal fixation, and interbody bone graft fusion (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eInclusion criteria were as follows: 1. fulfillment of the diagnostic criteria for brucellosis spondylitis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], completion of laboratory tests, X-ray, CT, and MRI examinations prior to surgery, and pathological confirmation of thoracolumbar brucellosis spondylitis during the operation; 2. fulfillment of the surgical indications for brucellosis spondylitis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; 3. absence of a history of spinal trauma; 4. adulthood without developmental spinal deformities; 5. absence of other etiological findings, such as Mycobacterium tuberculosis, Staphylococcus aureus, or fungi; and 6. availability of complete follow-up clinical imaging and laboratory examination data.\u003c/p\u003e \u003cp\u003eThis retrospective study was approved by the ethical committee and performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. All patients in this study voluntarily signed an informed consent form to join the scientific research and signed an informed consent form for surgical treatment.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003ePostoperative complications, such as incision infection, impaired wound healing, and recurrence, were systematically recorded.\u003c/p\u003e \u003cp\u003eThe following variables were collected: patient age and gender at the time of surgery, preoperative clinical symptoms such as fever and lower-limb manifestations, imaging findings including intraspinal, paravertebral, and psoas abscesses, and laboratory indicators such as white blood cell count, lymphocyte count, hemoglobin, erythrocyte sedimentation rate, C-reactive protein, albumin, and globulin. Preoperative conditions, including anemia, malnutrition, and underlying diseases such as diabetes, were documented. The surgical segment, operative time, and intraoperative blood loss were recorded.\u003c/p\u003e\n\u003ch3\u003ePreoperative preparation\u003c/h3\u003e\n\u003cp\u003eAll 61 patients underwent preoperative anti-Brucellosis drug therapy using either a triple or a quadruple regimen [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]: doxycycline 200 mg/d, rifampicin 600 mg/d, and levofloxacin 500 mg/d. Ceftriaxone sodium 2 g/d was included based on individual patient conditions. Each treatment course lasted 6 weeks, with a total of 2 to 3 courses administered. Throughout therapy, regular assessments of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), liver function, and renal function were conducted. Thoracolumbar braces were used to ensure immobilization and protection during the anti-brucellosis drug therapy.\u003c/p\u003e\n\u003ch3\u003eSurgical techniques\u003c/h3\u003e\n\u003cp\u003eThe patient is placed in the prone position. Vertebral pedicles are identified and marked using C-arm fluoroscopy. A posterior midline incision is made, followed by sequential incisions through the skin, subcutaneous tissue, and fascial layer. Bilateral dissection along the spinous processes is performed until the lamina and facet joints are exposed. Under fluoroscopic guidance, a positioning needle is used to localize the pedicle, after which a pedicle screw system is inserted. For selected thoracic vertebrae, screw insertion is assisted by a computer navigation system. Unilateral or bilateral fenestration and decompression are then performed. With direct visualization and the use of a discectomy endoscope, inflammatory tissues and damaged bone within the spinal canal, intervertebral space, and paravertebral area are thoroughly removed. The intervertebral space is cleared until fresh blood is observed, and the area is repeatedly irrigated using an irrigation gun. Crushed autologous bone is implanted into the intervertebral bone defect, and an intervertebral fusion cage is inserted obliquely. Compression is applied, and fixation is tightened. The area is irrigated again with the irrigation gun. After confirming hemostasis, a drainage tube is routinely placed, and the incision is sutured in layers. The lesion tissue obtained during the procedure is sent for pathological examination (Fig.\u0026nbsp;2).\u003c/p\u003e\n\u003ch3\u003ePostoperative Management\u003c/h3\u003e\n\u003cp\u003eSupportive care, including enhanced nutrition, should be administered following surgery. The drainage tube is to be removed within 2 to 3 days, contingent upon drainage status. Patients should wear a thoracolumbar brace and begin ambulation as tolerated. For the first three months, activity should be minimized, and bed rest prioritized. Postoperative anti-brucellosis pharmacotherapy must be continued.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using the SPSS software (version 25.0; IBM SPSS, New York). Continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or medians with interquartile ranges, while categorical variables were presented as the frequencies or percentages of events. The Mann-Whitney U test was used for non-normally distributed continuous variables, and a t-test was used for normally distributed continuous variables. Variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate logistic regression were included in the multivariate model to identify risk factors for complications. Relative risks and corresponding 95% confidence intervals were calculated. Statistical significance was defined as α\u0026thinsp;=\u0026thinsp;0.05 (two-sided).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eComparison of clinical data between the two groups\u003c/h2\u003e \u003cp\u003eA total of 61 patients were enrolled and categorized into a complication group or a control group based on the presence or absence of postoperative complications (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of clinical characteristic data between the complication group and the control group\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecomplication group (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecomplication group (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.07\u0026thinsp;\u0026plusmn;\u0026thinsp;12.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.40\u0026thinsp;\u0026plusmn;\u0026thinsp;7.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.358\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex(male/female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11/3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33/14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7/7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.978\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease duration(d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135(90,245)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90(60,180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.875\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16/31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower limb symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6/8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24/23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraspinal abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20/27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParavertebral abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11/3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31/16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsoas muscle abscesses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6/8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11/36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin level(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.84\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.09\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobulin level(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.40\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.94\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.703\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell count(x10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphocyte count(x10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.61(1.38,2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.81(1.34,2.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin level (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118.64\u0026thinsp;\u0026plusmn;\u0026thinsp;17.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131.11\u0026thinsp;\u0026plusmn;\u0026thinsp;12.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.441\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical segment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0(1.0, 2.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0(1.0, 3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time(h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0(2.88, 325)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0(2.8, 3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e370(300, 400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380(300, 400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe complication group comprised 14 patients, with 12 cases of delayed wound healing and 2 cases of recurrence. Of these patients, 11 were male, and 3 were female. Ages ranged from 26 to 68 years, with a mean age of 60.07\u0026thinsp;\u0026plusmn;\u0026thinsp;12.71 years. Seven patients had comorbid diabetes. Disease duration ranged from 30 to 260 days, with a median of 135 (90, 245) days. Clinical symptoms included fever in 9 patients and lower-limb symptoms in 6 patients. Imaging revealed intraspinal abscesses in 9 patients, paravertebral abscesses in 11 patients, and psoas abscesses in 6 patients.\u003c/p\u003e \u003cp\u003eThe control group included 47 patients, of whom 33 were male and 14 were female. Ages ranged from 38 to 72 years, with a mean age of 55.40\u0026thinsp;\u0026plusmn;\u0026thinsp;7.26 years. Twelve patients had comorbid diabetes. Disease duration ranged from 30 to 720 days, with a median of 90 (60, 180) days. Clinical symptoms included fever in 16 patients and lower-limb symptoms in 24 patients. Imaging revealed intraspinal abscesses in 20 patients, paravertebral abscesses in 31 patients, and psoas abscesses in 11 patients.\u003c/p\u003e \u003cp\u003eThere were statistically significant differences between the two patient groups in disease duration, fever status, and hemoglobin levels (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In contrast, no statistically significant differences were observed between the two groups for the following variables: age, gender, diabetes mellitus, lower-limb symptoms, intraspinal abscess, paravertebral abscess, psoas abscess, white blood cell count, lymphocyte count, hemoglobin level, albumin level, globulin level, surgical segment, operation time, and blood loss (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eRisk factors of postoperative complications\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUnivariate analysis: Variables such as age, gender, disease duration, comorbid diabetes, comorbid intraspinal abscess, paravertebral abscess, psoas major muscle abscess, surgical segments, operation time, blood loss, white blood cell count, lymphocyte count, hemoglobin, albumin, globulin, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were initially identified based on their potential clinical relevance as risk factors for postoperative complications in patients with thoracolumbar Brucella spondylitis. These variables were subsequently included in the logistic regression analysis. Statistically significant factors were diabetes (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040), fever (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.050), ESR (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018), CRP (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046), hemoglobin (HB) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010), and psoas major muscle abscess (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.042) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMultivariate logistic regression: Six indicators\u0026mdash;diabetes, fever, ESR, CRP, HB, and psoas major muscle abscess\u0026mdash;were identified in the univariate logistic analysis and included as independent variables in the multivariate model using the full-model regression method. Regression results: Diabetes, fever, and psoas major muscle abscess were significant predictors of postoperative complications in patients with thoracolumbar Brucella spondylitis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate logistic regression analysis of postoperative complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eWald χ2\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eOR 95% CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.992\u0026thinsp;~\u0026thinsp;1.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.155\u0026thinsp;~\u0026thinsp;2.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.993\u0026thinsp;~\u0026thinsp;1.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical segment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.694\u0026thinsp;~\u0026thinsp;3.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.791\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.363\u0026thinsp;~\u0026thinsp;3.781\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.996\u0026thinsp;~\u0026thinsp;1.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.950\u0026thinsp;~\u0026thinsp;0.995\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.924\u0026thinsp;~\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.872\u0026thinsp;~\u0026thinsp;1.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobulin level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.787\u0026thinsp;~\u0026thinsp;1.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.579\u0026thinsp;~\u0026thinsp;1.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphocyte count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.419\u0026thinsp;~\u0026thinsp;2.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.015\u0026thinsp;~\u0026thinsp;1.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.100\u0026thinsp;~\u0026thinsp;1.180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.082\u0026thinsp;~\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraspinal abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.119\u0026thinsp;~\u0026thinsp;1.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParavertebral abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.129\u0026thinsp;~\u0026thinsp;2.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsoas muscle abscesses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.088\u0026thinsp;~\u0026thinsp;1.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Logistic Regression Analysis of Postoperative Complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eS E\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eWald χ2\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eOR 95% CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.881\u0026thinsp;~\u0026thinsp;1.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.931\u0026thinsp;~\u0026thinsp;1.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.811\u0026thinsp;~\u0026thinsp;1.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.013\u0026thinsp;~\u0026thinsp;1.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.122\u0026thinsp;~\u0026thinsp;6.344\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsoas muscle abscesses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.018\u0026thinsp;~\u0026thinsp;1.398\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eBrucellar spondylitis is caused by Brucella infecting the spine. Current treatments are mainly drugs or surgery. Surgery is necessary when drugs do not relieve symptoms, when there are large paravertebral or psoas abscesses, or when vertebrae are unstable. Because incisions are contaminated and patients' immune systems are weak, wound healing is often poor, and the risks of infection and recurrence are higher. This study found that diabetes, fever, and psoas muscle abscess independently increase the risk of postoperative complications in thoracolumbar brucellar spondylitis and should be addressed during perioperative management.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe relationship between diabetes and postoperative complications\u003c/h2\u003e \u003cp\u003eDiabetes is the most prevalent endocrine disorder worldwide, with China reporting the highest number of diabetic patients [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Previous studies have identified diabetes as an independent risk factor for postoperative wound infection following spinal surgery [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The co-occurrence of brucellar spondylitis and diabetes necessitates the simultaneous management of a specific infection and a complex systemic metabolic disorder. These conditions can interact, substantially increasing the complexity and risk associated with diagnosis and treatment. Diabetes impairs leukocyte function and causes circulatory disorders, thereby reducing the body's ability to eliminate Brucella and complicating infection control. Additionally, diabetic patients often exhibit a chronic low-grade inflammatory state. Following Brucella infection, these patients may experience a heightened inflammatory response, resulting in more severe and extensive bone destruction, an increased risk of abscess formation\u0026mdash;particularly paravertebral or psoas abscesses that are difficult to resolve\u0026mdash;and a greater likelihood of nerve damage due to inflammation and abscesses compressing the spinal cord or nerve roots.\u003c/p\u003e \u003cp\u003eIn this study, 50.00% (7/14) of patients in the complication group had diabetes. In patients with both brucellar spondylitis and diabetes, the use of hypoglycemic drugs can cause subcutaneous fat thickening. Intraoperative traction may damage this fat, leading to fat liquefaction, poor wound healing, or infection. Diabetic patients are also prone to microvascular lesions. The use of electrocoagulation during surgery may damage blood vessels, resulting in ischemia and hypoxia of the incision tissue, which can further contribute to poor wound healing or infection [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, hyperglycemia in diabetic patients can reduce the synthesis of substances such as collagen fibers that promote wound healing, leading to delayed postoperative recovery.\u003c/p\u003e \u003cp\u003eCurrently, there is a paucity of studies, both domestically and internationally, that examine brucellosis complicated by diabetes. Yumuk Z [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and colleagues infected diabetic rats with Brucella and observed a worsening of their condition following infection. Additionally, Widdrington JD [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and colleagues identified diabetes as a risk factor for mortality in spondylitis in a large-scale retrospective study.\u003c/p\u003e \u003cp\u003eFor patients with brucellar spondylitis complicated by diabetes, it is essential to maintain strict blood glucose control during the perioperative period. Timely adjustment of the hypoglycemic regimen is recommended to minimize the risk of complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eThe relationship between fever and postoperative complications\u003c/h2\u003e \u003cp\u003eIn brucellosis spondylitis, fever often occurs in the afternoon, typically exceeding 38\u0026deg;C, and is accompanied by profuse sweating [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this study, 64.29% (9/14) of patients in the complication group had concurrent fever. During the febrile period, a large number of bacteria are present in the vertebral lesions, and tissues are in a state of acute or sub-acute suppurative inflammation and edema, with abundant blood supply but fragile structure. Although the lesion is located in the spine, fever indicates bacteria may enter the bloodstream, posing a risk of bacteremia or septicemia, and the immune system is under stress [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. If the fever is not controlled before surgery, many viable bacteria remain in the surgical area. Although most lesions are removed during surgery, remaining bacteria may proliferate due to low post-operative immunity or local hematoma, leading to poor wound healing or recurrence.\u003c/p\u003e \u003cp\u003eThis study identifies preoperative active fever as an independent risk factor for postoperative complications in brucellosis spondylitis. Nonhealing of the surgical wound and recurrence are linked to this risk. Control fever and stabilize the disease before elective surgery to reduce complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eThe relationship between psoas major muscle abscess and postoperative complications\u003c/h2\u003e \u003cp\u003eFollowing spinal invasion by Brucella, granulomas proliferate beneath the cartilaginous endplate. Disease progression results in expansion of the affected area, bone destruction, and narrowing of the intervertebral space. Rupture of paravertebral lymph nodes may lead to paravertebral or psoas muscle abscesses [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Esmaeilnejad-Ganji SM [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and colleagues reported that thoracolumbar pain in brucellar spondylitis is associated with epidural, paravertebral, and psoas muscle abscesses. Clinical outcomes remain poor in the presence of abscesses, even with rigorous treatment. Yang B [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and others observed that, compared to spinal tuberculosis, brucellar spondylitis is characterized by bone destruction with concurrent bone hyperplasia, and abscesses are typically limited to the vicinity of the affected vertebral bodies. Ulu-Kilic A [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and colleagues analyzed clinical data from 293 patients with brucellar spondylitis and identified psoas muscle abscesses in only 10 cases, indicating a relatively low incidence. They concluded that psoas muscle abscesses are uncommon in brucellar spondylitis. In the present study, 42.85% (6/14) of patients in the complication group exhibited psoas muscle abscesses. Compared to spinal tuberculosis, brucellar spondylitis is associated with fewer cases of psoas muscle abscesses. Consequently, inadequate perioperative attention and incomplete debridement of psoas muscle abscesses during surgery may increase the risk of postoperative complications.\u003c/p\u003e \u003cp\u003eThis study utilized the posterior surgical approach. Traditionally, brucellar spondylitis has been managed with a combined anterior-posterior approach, which is associated with significant surgical trauma, increased procedural risks, greater demands for spinal stability reconstruction, occasional insufficient fixation strength, the need for intraoperative repositioning, and higher physical requirements for patients [\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In recent years, the posterior approach has gained preference among surgeons, as it mitigates these disadvantages and can significantly reduce recurrence rates [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Although multiple studies have demonstrated that posterior surgery for brucellar spondylitis yields satisfactory clinical outcomes, REN HL [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and colleagues identified limitations of the posterior approach, including a restricted visual field. This limitation is particularly problematic in cases with paravertebral or psoas abscesses, where complete lesion removal is challenging and may compromise surgical efficacy.\u003c/p\u003e \u003cp\u003eTherefore, in clinical management of brucellar spondylitis complicated by psoas muscle abscesses, careful preoperative assessment, meticulous surgical planning, and strict adherence to operative protocols are essential to minimize postoperative complications.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, diabetes, fever, and psoas abscess are significant risk factors for postoperative complications in patients with thoracolumbar Brucella spondylitis. To reduce these complications, surgical indications should be selected judiciously, surgical procedures must be rigorously followed, blood glucose in diabetic patients should be controlled, and preoperative body temperature must be managed appropriately. Due to the study's limitations, including a small sample size and absence of multicenter data, future research should focus on larger, collaborative studies to validate and extend these findings. Health professionals should implement these recommendations and support broader clinical investigations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eerythrocyte sedimentation rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCRP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eC-reactive protein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMRI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emagnetic resonance imaging\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis retrospective study was approved by the ethical committee of Beijing Ditan Hospital, Capital Medical University and performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. And all participants signed informed consent for publication.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYZ and CSZ conceived the manuscript, participated in the collection of clinical data and manuscript writing; YZ and JMC participated in the pathological examination, YZ and QZ participated in the manuscript revision. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors thank the participants for making this study possible and the Department of Pathology for technical support.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen J, Zhi F, Zhao G, Su M, Geng H, Song W, Chu Y, Zhang H. \u003cem\u003eBrucella\u003c/em\u003e osteoarthritis: recent progress and future directions. Front Microbiol. 2025;16:1522537. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fmicb.2025.1522537\u003c/span\u003e\u003cspan address=\"10.3389/fmicb.2025.1522537\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli Adam A, Sheikh Hassan M, Adam Osman A. Spinal brucellosis causing spondylodiscitis. Ann Med Surg (Lond). 2022;82:104782. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amsu.2022.104782\u003c/span\u003e\u003cspan address=\"10.1016/j.amsu.2022.104782\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu Z, Shi Y, Xue C, Yuan M, Li Z, Zheng C. Epidemiological and Spatiotemporal Clustering Analysis of Human Brucellosis - China, 2019\u0026ndash;2023. China CDC Wkly. 2025;7(4):130\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.46234/ccdcw2025.020\u003c/span\u003e\u003cspan address=\"10.46234/ccdcw2025.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe K, Xing W. Efficacy of spinal fusion in Brucella spondylitis: a systematic review. Front Surg. 2025;12:1537153. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fsurg.2025.1537153\u003c/span\u003e\u003cspan address=\"10.3389/fsurg.2025.1537153\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin M, Fan Z, Gao R, Li X, Gao Z, Wang Z. Research progress on complications of \u003cem\u003eB\u003c/em\u003erucellosis. Front Cell Infect Microbiol. 2023;13:1136674. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fcimb.2023.1136674\u003c/span\u003e\u003cspan address=\"10.3389/fcimb.2023.1136674\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng Y, Liu X, Duan K, Peng Q. Res Progress Brucellosis Curr Med Chem. 2019;26(30):5598\u0026ndash;608. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2174/0929867325666180510125009\u003c/span\u003e\u003cspan address=\"10.2174/0929867325666180510125009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan AK, Sharma V, Robinson LC, Mummaneni PV. Summary of Guidelines for the Treatment of Lumbar Spondylolisthesis. Neurosurg Clin N Am. 2019;30(3):353\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.nec.2019.02.009\u003c/span\u003e\u003cspan address=\"10.1016/j.nec.2019.02.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpernovasilis N, Karantanas A, Markaki I, Konsoula A, Ntontis Z, Koutserimpas C, Alpantaki K. \u003cem\u003eBrucella\u003c/em\u003e Spondylitis: Current Knowledge and Recent Advances. J Clin Med. 2024;13(2):595. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm13020595\u003c/span\u003e\u003cspan address=\"10.3390/jcm13020595\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeng Z, Wang X, Yin X, Han J, Tang W. Analysis of the Curative Effect of Posterior Approach on Lumbar Brucellar Spondylitis with Abscess through Magnetic Resonance Imaging under Improved Watershed Algorithm. Contrast Media Mol Imaging. 2021;2021:1933706. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2021/1933706\u003c/span\u003e\u003cspan address=\"10.1155/2021/1933706\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuan H, Liu K, Deng X, Sheng W, Mamat M, Guo H, Li H, Deng Q. One-stage posterior surgery combined with anti-Brucella therapy in the management of lumbosacral brucellosis spondylitis: a retrospective study. BMC Surg. 2022;22(1):394. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12893-022-01847-x\u003c/span\u003e\u003cspan address=\"10.1186/s12893-022-01847-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee CC, Chen CW, Yen HK, Lin YP, Lai CY, Wang JL, Groot OQ, Janssen SJ, Schwab JH, Hsu FM, Lin WH. Comparison of Two Modern Survival Prediction Tools, SORG-MLA and METSSS, in Patients With Symptomatic Long-bone Metastases Who Underwent Local Treatment With Surgery Followed by Radiotherapy and With Radiotherapy Alone. Clin Orthop Relat Res. 2024;482(12):2193\u0026ndash;208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/CORR.0000000000003185\u003c/span\u003e\u003cspan address=\"10.1097/CORR.0000000000003185\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePan S, Chen S, Zhou K, Wu J, Wu C, Tuerxun M, Chong Y, Zhu J. Development and validation of a clinico-biological score for Brucella spondylitis: a two-center study. BMC Infect Dis. 2025;25(1):1445. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-025-11886-3\u003c/span\u003e\u003cspan address=\"10.1186/s12879-025-11886-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Zhao C, Chen J, Zhang Q. Beneficial influence of single-stage posterior surgery for the treatment of lumbar brucella spondylitis combined with spondylolisthesis. Sci Rep. 2022;12(1):19459. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-022-24223-4\u003c/span\u003e\u003cspan address=\"10.1038/s41598-022-24223-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang SH, Dou KF, Song WJ. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362(25):2425\u0026ndash;6. author reply 2426.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu Y, Lu J, Li M, Wang T, Wang K, Cao Q, Ding Y, Xiang Y, Wang S, Yang Q, Zhao X, Zhang X, Xu M, Wang W, Bi Y, Ning G. Diabetes in China part 2: prevention, challenges, and progress. Lancet Public Health. 2024;9(12):e1098\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2468-2667(24)00251-2\u003c/span\u003e\u003cspan address=\"10.1016/S2468-2667(24)00251-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXavier LFD, Medeiros AS, Melo MCSF, Santos RNG, Gama ZADS, Freitas MR. Improvement project to reduce surgical site infections: a retrospective cohort study. Rev Col Bras Cir. 2023;50:e20233380. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/0100-6991e-20233380-en\u003c/span\u003e\u003cspan address=\"10.1590/0100-6991e-20233380-en\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang X, Liu P, You J. Risk factors for surgical site infection following spinal surgery: A meta-analysis. Med (Baltim). 2022;101(8):e28836. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000028836\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000028836\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaruwatari R, Yamada K, Sato K, Yokosuka K, Yoshida T, Nakae I, Shimazaki T, Morito S, Shiba N. Risk Factors for Surgical Site Infection in Spinal Surgery and Interventions: A Retrospective Study. Kurume Med J. 2023;68(34):201\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2739/kurumemedj.MS6834004\u003c/span\u003e\u003cspan address=\"10.2739/kurumemedj.MS6834004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYumuk Z, K\u0026uuml;\u0026ccedil;\u0026uuml;kbasmaci O, B\u0026uuml;y\u0026uuml;kbaba Boral O, K\u0026uuml;\u0026ccedil;\u0026uuml;ker Anğ M, Dundar V. The effects of streptozotocin-induced diabetes on brucellosis of rats. FEMS Immunol Med Microbiol. 2003;39(3):275\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0928-8244(03)00257-8\u003c/span\u003e\u003cspan address=\"10.1016/S0928-8244(03)00257-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiddrington JD, Emmerson I, Cullinan M, Narayanan M, Klejnow E, Watson A, Ong ELC, Schmid ML, Price DA, Schwab U, Duncan CJA. Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice. Med Sci (Basel). 2018;6(4):96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/medsci6040096\u003c/span\u003e\u003cspan address=\"10.3390/medsci6040096\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu ZG, Song ZY, Wang WX, Xi WN, Jin D, Ai MX, Wu YC, Lan Y, Song SF, Zhang GC, Yao XB, Gao Z, Liu CY, Sun K, Yu DS, Xie BG, Sun SL. Human brucellosis and fever of unknown origin. BMC Infect Dis. 2022;22(1):868. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-022-07872-8\u003c/span\u003e\u003cspan address=\"10.1186/s12879-022-07872-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu ZG, Song ZY, Wang WX, Xi WN, Jin D, Ai MX, Wu YC, Lan Y, Song SF, Zhang GC, Yao XB, Gao Z, Liu CY, Sun K, Yu DS, Xie BG, Sun SL. Correction: Human brucellosis and fever of unknown origin. BMC Infect Dis. 2023;23(1):23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-023-07986-7\u003c/span\u003e\u003cspan address=\"10.1186/s12879-023-07986-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurns RJL, Le KK, Siengsanun-Lamont J, Blacksell SD. A review of coxiellosis (Q fever) and brucellosis in goats and humans: Implications for disease control in smallholder farming systems in Southeast Asia. One Health. 2023;16:100568. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.onehlt.2023.100568\u003c/span\u003e\u003cspan address=\"10.1016/j.onehlt.2023.100568\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayoun MA, Muco E, Shorman M, Brucellosis. 2023 Apr 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang T, Ma L, Liu H, Zhang L, Yang C, Li S. Clinical characteristic, management, and outcomes of cervical spinal brucellosis: a retrospective cohort study over 1-year postoperative follow-up. J Orthop Surg Res. 2024;19(1):378. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13018-024-04868-9\u003c/span\u003e\u003cspan address=\"10.1186/s13018-024-04868-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao S, Hu Y, Mamat F, Xun C, Li H, Liang W, Cai X, Sheng W. Anterior debridement, reconstruction, and fusion for cervical brucellosis spondylitis with epidural abscess: a single-center experience of 30 patients. Eur Spine J. 2025;34(10):4680\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00586-025-09038-x\u003c/span\u003e\u003cspan address=\"10.1007/s00586-025-09038-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: A review. World J Orthop. 2019;10(2):54\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5312/wjo.v10.i2.54\u003c/span\u003e\u003cspan address=\"10.5312/wjo.v10.i2.54\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang B, Hu H, Chen J, He X, Li H. The Evaluation of the Clinical, Laboratory, and Radiological Findings of 16 Cases of Brucellar Spondylitis. Biomed Res Int. 2016;2016:8903635. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2016/8903635\u003c/span\u003e\u003cspan address=\"10.1155/2016/8903635\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlu-Kilic A, Karakas A, Erdem H, Turker T, Inal AS, Ak O, Turan H, Kazak E, Inan A, Duygu F, Demiraslan H, Kader C, Sener A, Dayan S, Deveci O, Tekin R, Saltoglu N, Aydın M, Horasan ES, Gul HC, Ceylan B, Kadanalı A, Karabay O, Karagoz G, Kayabas U, Turhan V, Engin D, Gulsun S, Elaldı N, Alabay S. Update on treatment options for spinal brucellosis. Clin Microbiol Infect. 2014;20(2):O75\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/1469-0691.12351\u003c/span\u003e\u003cspan address=\"10.1111/1469-0691.12351\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang D, Ma L, Wang X, Xu Z, Sun G, Jia R, Wu Y, Zhang Y. Comparison of two surgical interventions for lumbar brucella spondylitis in adults: a retrospective analysis. Sci Rep. 2023;13(1):16684. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-023-43812-5\u003c/span\u003e\u003cspan address=\"10.1038/s41598-023-43812-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYin XH, Liu ZK, He BR, Hao DJ. One-stage surgical management for lumber brucella spondylitis with anterior debridement, autogenous graft, and instrumentation. Med (Baltim). 2018;97(30):e11704. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000011704\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000011704\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu C, Liu Q, Zheng J, Niu N, Shi J, Yang Z. Selection of treatment strategies for lumbar Brucella spondylitis: a retrospective clinical study. Front Surg. 2024;11:1365498. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fsurg.2024.1365498\u003c/span\u003e\u003cspan address=\"10.3389/fsurg.2024.1365498\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Y, Ma X. Clinical efficacy analysis of one-stage posterior debridement, bone graft fusion, and internal fixation for the treatment of lumbar brucellosis spondylitis. BMC Surg. 2025;25(1):391. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12893-025-03143-w\u003c/span\u003e\u003cspan address=\"10.1186/s12893-025-03143-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo Y, Yang Y, Chen Z, Feng D, Lei F. One-stage posterior debridement approach combined with autogenous bone grafting and internal fixation for the treatment of adult thoracic or lumbar suppurative spondylitis via the multifidus and longissimus interspaces. J Orthop Surg Res. 2025;20(1):330. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13018-025-05735-x\u003c/span\u003e\u003cspan address=\"10.1186/s13018-025-05735-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRen HL, Jiang JM, Wang JX, Qu DB, Chen JT. Is duration of preoperative anti-tuberculosis treatment a risk factor for postoperative relapse or non-healing of spinal tuberculosis? Eur Spine J. 2016;25(12):3875\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00586-016-4496-2\u003c/span\u003e\u003cspan address=\"10.1007/s00586-016-4496-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Thoracolumbar spine, Brucellosis spondylitis, Postoperative complications, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-8435058/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8435058/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study aimed to identify risk factors for postoperative complications following a one-stage posterior approach for thoracolumbar Brucellosis spondylitis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively analyzed data from 61 patients with thoracolumbar Brucellosis spondylitis who underwent a one-stage posterior approach at this institution between January 2015 and January 2019. To compare clinical characteristics, patients were divided into two groups based on the presence of postoperative complications: a complication group (14 cases) and a control group (47 cases). Logistic regression analysis was then used to identify factors associated with postoperative complications.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDisease duration, fever status, and hemoglobin levels differed significantly between groups (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Further, multivariate analysis identified diabetes, fever, and psoas muscle abscess as independent risk factors for postoperative complications (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHaving diabetes, fever, and psoas muscle abscess are independent risk factors for complications after a one-stage posterior approach for thoracolumbar Brucellosis spondylitis. Therefore, careful selection of surgical indications, strict surgical technique, proper blood glucose management in diabetic patients, and preoperative control of body temperature are essential to reduce complication rates.\u003c/p\u003e","manuscriptTitle":"Analysis of Risk Factors for Postoperative Complications of Thoracolumbar Brucella Spondylitis ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 09:08:12","doi":"10.21203/rs.3.rs-8435058/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-24T09:26:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-27T23:23:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"36417928580593030076452135804171345920","date":"2026-02-26T05:39:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-25T11:39:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78816168339352930611199445123566592835","date":"2026-01-10T05:57:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T05:41:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-26T12:59:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-26T05:37:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-26T05:36:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-12-23T14:32:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ad6e767-caf9-4c13-ac95-931ff0fecc41","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-24T09:41:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 09:08:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8435058","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8435058","identity":"rs-8435058","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}