Cervical brucellar spondylitis: Current management strategies and future directions

Cervical brucellar spondylitis (CBS) is a rare but severe form of osteoarticular brucellosis requiring heightened clinical vigilance. This review delineates current management strategies and proposes future directions for CBS, based on a comprehensive analysis of 37 studies (encompassing 101 CBS cases) identified through searches of PubMed, Embase, and the Cochrane Library databases. CBS most commonly manifests with neck pain (occurring in 98% of patients) and neurological deficits (77%). Characteristic imaging findings include T1-weighted hypointensity and T2-weighted hyperintensity affecting the intervertebral discs and adjacent vertebrae, frequently accompanied by epidural abscesses (65.3%), while vertebral bone destruction is less common (30.7%). The cervical segments most frequently involved are C5-C6 (28.7%), followed by C4-C5 (19.8%) and C6-C7 (19.8%). First-line antimicrobial therapy typically involves a combination of doxycycline and rifampin administered for 6-12 weeks. Conservative treatment is the recommended approach for patients without severe neurological deficits, significant bone destruction, or spinal instability. Surgical intervention (utilizing anterior, posterior, or combined approaches) is indicated for cases involving progressive neurological deterioration, radiographic progression, or failure of conservative therapy. Effective management of CBS requires strict adherence to the core principles of early and accurate diagnosis, standardized antimicrobial treatment, and precise intervention. Future strategies should focus on advancing rapid molecular diagnostics, innovating drug therapies and surgical techniques, and enhancing multidisciplinary collaboration to improve clinical outcomes in CBS patients.