Human brucellosis is one of the most common zoonotic infectious diseases [6, 7]. It is more common among animal breeders, those who consume unpasteurized dairy products, farmers, veterinarians, and laboratory workers [8, 9]. In China, human brucellosis is still a serious public health problem. From 2007 to 2017, the number of reported cases increased by 7.8% every year, and the natural foci were also more widespread[2, 7, 10]. Spinal epidural abscesses caused by brucellosis are rare [9, 11–18]. Among the 14 cases in this group, 8 cases had a history of contact with cattle and sheep and a history of eating unpasteurized dairy products. Among the 60 cases in the literature, 28 cases had a history of contact with cattle and sheep, and a history of eating non-pasteurized dairy products.
In this group of cases and literature, the most common clinical manifestations of SEA are focal spinal pain, neurological dysfunction, and fever, that is, the typical SEA diagnosis of triad . Some patients have arthritis, low-grade fever, night sweats, fatigue, loss of appetite, hepatosplenomegaly, etc. [18, 20]. The clinical symptoms of SEA are often not typical enough, with poor specificity , and clinical diagnosis is often delayed . SEA often invades the lumbar spine, followed by the cervical and thoracic spine . The most common in this group and literature review is the lumbar spine, followed by the cervical and thoracic spine.
SEA requires early diagnosis and appropriate treatment to improve the prognosis . CRP and ESR can be increased in the early stage of infection, and have a high specificity for the diagnosis of infection . The etiological diagnosis of Brucella usually requires Brucella latex agglutination test, blood culture, tissue culture, etc. . Brucella species can be cultured in blood or tissue samples to authoritatively diagnose brucellosis, but the positive rate is low. Most reports in the literature are diagnosed by brucella serology [12, 25, 26]. Magnetic resonance imaging (MRI) is the gold standard for diagnosis of SEA [15, 27, 28]. X-ray and CT are convenient and quick, and can better show the condition of bone involvement, but the diagnosis of SEA is not as good as MRI. The typical manifestations of MRI are: low signal on T1WI, high signal on T2WI, heterogeneous signal and enhanced thick-walled abscess (ring enhancement) on T1WI enhanced image . Research by Xinxin Liu et al.  showed that, compared with tuberculous spondylitis, brucellosis spondylitis can be observed on MRI with complete vertebral height and more uniform high signal intensity.
At present, there is no guideline to guide the standardized treatment of SEA, and there are still great differences in the best clinical treatment of SEA . The decision to choose non-surgical or surgical treatment for spinal epidural abscesses depends to a large extent on whether the patient has a movement disorder and whether it is at risk of developing a movement disorder . Pourtaheri S et al found that compared with the use of antibiotics alone, SEA patients undergoing surgery or drainage can obtain greater infection clearance and lower mortality. Historically, early surgery combined with antibacterial therapy has always been the mainstream treatment for SEA . In the past 10 years, SEA medical management has been chosen by more and more people [33, 34], that is, when there is no neurological dysfunction or mild neurological dysfunction, conservative treatment can be performed first, and conservative treatment is not good. Or when the condition deteriorates, surgery is performed again; patients with mild or more neurological dysfunction should be treated immediately. In this group of cases, 11 patients (11/14) underwent surgery combined with anti-bruchella treatment. Since our hospital is a large regional tertiary medical diagnosis and treatment center and teaching hospital, most of the patients admitted are difficult and severe patients and referrals from lower-level hospitals Most of them cannot be improved with conservative treatment, so multiple operations are combined with anti-brucella treatment.
Regardless of whether it is associated with epidural abscess, Brucella infection must be treated with antibiotics once it is diagnosed . The ideal antibiotic treatment plan and duration of treatment for brucella spinal abscess are still controversial . The WHO recommends combining doxycycline (also known as doxycycline) and streptomycin for at least 12 weeks as the first-line treatment . Stahl JP and others recommended the use of doxycycline combined with rifampicin for antibacterial therapy . Tan Hu et al.  recommended the use of doxycycline, rifampicin and levofloxacin for 8–12 weeks, but the specific duration depends on the clinical response (including blood routine, ESR, CRP, renal and liver function, X-ray Film or even MRI etc.). Most cases in this group were treated with doxycycline, rifampicin and levofloxacin for 12 weeks or more. ESR, CRP, renal and liver function, and Brucella latex agglutination test titers were reviewed regularly.