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[目的]通过回顾性比较单纯后路与前后路联合手术疗效,探讨腰椎布病性脊椎炎术式的选择.[方法]回顾性分析2007年6月～2015年6月手术治疗获得完整随访的65例腰椎布鲁杆菌性脊椎炎患者的临床及影像学资料.依据骨破坏情况、脓肿位置、神经损害及影像学分型,35例采用单纯后路椎板减压病灶清除椎弓根钉固定横突间植骨融合(单纯组),31例行前路病灶清除,同期联合后路椎弓根钉固定植骨术(联合组).比较两组在手术时间、术中出血量、疼痛视觉模拟VAS评分、Oswestry功能障碍指数(Oswestry disability index)、ESC、影像学评价、脊柱后凸角(Cobb角)及ASIA评分改善的差异.[结果]两组手术时间、术中出血量、住院时间、ESC、脊柱后凸角(Cobb角)比较差异无统计学意义;影像学评价、VAS评分、ODI评分、ASIA评分比较术后1周差异有统计学意义,术后6个月差异无统计学意义.[结论]两种术式均能有效清除病灶,维持或重建脊柱稳定,有利于感染控制.单纯后路手术对于椎管内肉芽及脓肿清除效果较好,更适合中后柱病变特别是椎管内神经损害者;而前后路联合手术更适合存在椎体周围脓肿及腰大肌脓肿或前柱破坏较大病例.临床中应依据个性化治疗原则,根据感染浸润情况采取不同手术方式.“,”[Objective] To explore selection of surgical approaches by comparing retrospectively the clinical outcomes of posterior only versus combined anterior with posterior approaches for treatment of lumbar brucellosis spondylitis.[Methods] A retrospective study was conducted on the clinical and imaging data of 65 patients with lumbar Brucella spondylitis who were surgically treated from June 2007 to June 2015,and followed up completely.According to the bone destruction,abscess position,nerve lesion and imaging classification,35 patients received decompression,focal debridement,pedicle screw fixation and intertransverse fusion by a single posterior approach (the posterior group),whereas 31 patients had debridement through an anterior approach combined with pedicle screw fixation and intertransverse fusion by a posterior approach in the same stage (combined A-P group).The operation time,blood loss,visual analogue scale (VAS),Oswestry disability index (ODI),ESR,AISA classification,postoperative complications,as well as radiographic grading and the kyphosis angle (Cobb angle)were compared between the two groups.[Results] No significant differences were noted in operation time,bleeding during operation,ESR,and the kyphosis angle (Cobb angle) between the two groups (P＞0.05).However,significant differences were found between the two groups in the radiographic grades,VAS,ODI and AISA at one week after operation (P＜0.05),although they diminished 6 months after the operation (P＞0.05).[Conclusion] Both the operation methods achieve effective removal of the lesions,maintaining or rebuilding the spine stability which contributes to controlling the infection.The simple posterior operation is suitable for the debridement of spinal canal granulation and abscess involving the middle or posterior column,especially accompanied by nerve pathology,while the combined anterior and posterior approach facilities to remove lesion and abscess involving psoas major and the anterior column.Concrete surgical protocols should be selected based on individualized treatment principle and the condition of infection affected.