Ma Zhong, Liu Xin, Zhang Mingtao, Wu Zuolong, Zhang Xianxu, Li Shicheng, An Jiangdong, Luo Zhiqiang
Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, 730000, China.
Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, Gansu, 730000, China.
Eur Spine J. 2025 Feb;34(2):675-683. doi: 10.1007/s00586-025-08647-w. Epub 2025 Jan 7.
Spinal tuberculosis (STB) and Brucella spondylitis (BS) represent two types of granulomatous infections affecting the spine, which exhibit significant similarities that often result in misdiagnosis and overlooked diagnoses during preoperative evaluations. This study aims to identify non-invasive evaluative indicators that facilitate the differentiation between STB and BS.
This study conducted a retrospective collection of clinical features, laboratory tests, and imaging characteristics from 89 patients diagnosed with STB and 66 patients diagnosed with BS. Differences were assessed utilizing χ² tests, independent non-parametric tests, Mann-Whitney U tests, or Fisher's exact tests. Binary logistic regression analysis was employed to identify independent predictive factors for differential diagnosis, and receiver operating characteristic (ROC) curves were generated to assess the effectiveness by calculating the area under the curve (AUC).
Root symptoms (including limb pain and numbness) and necrosis formation exhibited statistically significant differences, with P values of 0.024 and 0.045, respectively. Furthermore, gender, decreased A/G ratio, involvement of thoracic vertebrae, number of damaged vertebrae, and straightening of spinal curvature were identified as independent predictive factors for differentiating between STB and BS, with P values of 0.009, 0.003, < 0.001, 0.005, and 0.014, respectively. ROC analysis revealed that the AUC and 95% confidence intervals (CIs) for these five evaluative indicators were 0.626 (0.537-0.714), 0.621 (0.533-0.709), 0.694 (0.612-0.777), 0.597 (0.508-0.686), and 0.631 (0.540-0.722), respectively. The predictive model exhibited an AUC and 95% CI of 0.854 (0.796-0.911), indicating strong predictive performance.
Statistically significant differences were observed between STB and BS regarding root symptoms and necrosis formation. In cases where the patient is male, presents with a decreased A/G ratio, does not have thoracic vertebra involvement, number of vertebral body destructions < 2.5, and exhibits straightening of spinal curvature, the likelihood of diagnosing BS is significantly greater than that of STB.
脊柱结核（STB）和布鲁氏菌脊柱炎（BS）是影响脊柱的两种肉芽肿性感染类型，它们具有显著相似性，这常导致术前评估时误诊和漏诊。本研究旨在确定有助于区分STB和BS的非侵入性评估指标。
本研究回顾性收集了89例诊断为STB的患者和66例诊断为BS的患者的临床特征、实验室检查及影像学特征。采用χ²检验、独立非参数检验、曼-惠特尼U检验或费舍尔精确检验评估差异。采用二元逻辑回归分析确定鉴别诊断的独立预测因素，并绘制受试者工作特征（ROC）曲线，通过计算曲线下面积（AUC）评估有效性。
根性症状（包括肢体疼痛和麻木）和坏死形成表现出统计学显著差异，P值分别为0.024和0.045。此外，性别、A/G比值降低、胸椎受累、椎体破坏数量及脊柱侧弯变直被确定为区分STB和BS的独立预测因素，P值分别为0.009、0.003、<0.001、0.005和0.014。ROC分析显示，这五个评估指标的AUC及95%置信区间（CI）分别为0.626（0.537 - 0.714）、0.621（0.533 - 0.709）、0.694（0.612 - 0.777）、0.597（0.508 - 0.686）和0.631（0.540 - 0.722）。预测模型的AUC及95%CI为0.854（0.796 - 0.911），表明具有较强的预测性能。
STB和BS在根性症状和坏死形成方面存在统计学显著差异。若患者为男性、A/G比值降低、无胸椎受累、椎体破坏数量<2.5且脊柱侧弯变直，则诊断为BS的可能性显著大于STB。
