PMC9651031_01
Radiological studies before operation. Plain radiograph showed narrowing of lumbar space 4-5 (A and B). CT showed dense pore-like destruction of the 4-5 lumbar vertebrae and intervertebral discs (C and D). Sagittal MRI showed vertebral and intervertebral disc lesions with low signal in T1, high signal in T2, and high signal in fat compression image, which was significantly enhanced after enhancement (E-H). Coronal MRI demonstrates a large, marked paravertebral abscess with unclear margins and enhancement (I and J). Axial MRI showed destruction of vertebral bodies and intervertebral discs, and significant strengthening of psoas after enhancement (K and L).
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The L4/5 vertebral space was narrowed on the preoperative X-ray (Figure 1A and B). Preoperative CT showed the intervertebral disc of L4/5 and adjacent vertebral body were heavily damaged with dense pores (Figure 1C and D). Preoperative sagittal MRI showed vertebral body and intervertebral disc lesions with low signal on T1-weighted imaging (T1WI), high signal on T2-weighted imaging (T2WI), and high signal on fat-suppressed T2-weighted imaging (FS-T2WI), which was significantly enhanced after enhancement (Figure 1E-H). Coronal and transverse MRI showed vertebral body damage of L4 and L5 complicated by intervertebral disc damage of L4/5 (Figure 1I-L). 
Intraoperatively, patients were treated with streptomycin to treat infection (A). Surgical specimens (B). Postoperative plain radiographs showed that the L4/5 vertebral space height was restored and the internal fixation was firm (C and D).
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Following general anesthesia, lumbar posterior lesion removal, decompression, internal fixation, cage implantation, and bone graft fusion were performed (Figure 2A-D).
Brucella melitensis was detected by real-time PCR, real-time PCR showed that the DNA content of Brucella melitensis (dotted red line) increased in 30 cycles. The ordinate represents the fluorescence intensity, the abscissa represents the number of PRC cycles, the blue realization represents the baseline level, and the red realization represents the positive reference.
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Real-time PCR of the nucleus pulposus samples showed that there was B. melitensis (Figure 3).  
In postoperative pathology, Brucella (red circle) was positive for Giemsa staining (A). Mycobacterium tuberculosis was negative for acid-fast staining of the intervertebral disc of L4/5 (B).
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Salmonella enteritis was detected in intraoperative pus secretions 7 days after surgery, and the pathological Giemsa staining of intraoperative tissues (nucleus pulposus, endplate cartilage) showed Brucella contamination (Figure 4).
Radiological studies 2 years after discharge. Plain radiographs showed no abnormal changes in the fixed position of L4-L5 vertebral segments (A and B). No abnormalities on CT and MRI (C-J).
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A follow-up 2 years later revealed normal CRP and ESR, Hb 119 g/L, and RBC 3.95x1012/L; X-ray showed a good position of internal fixation (Figure 5A and B); CT showed well fusion of L4 and L5 vertebral body, suggesting the formation of new bone in L4/5 disc space (Figure 5C-F); MRI demonstrated a good repair of the lesion (Figure 5G-J).