Chen Jinmei, Guo Qingxin, Tian Luying, Shen Leer, Zhang Yi, Jiao Qiong, Lian Xiaofeng, Chen Xiaohua
Department of Infectious Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pathology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Neurol. 2025 Aug 22;16:1623598. doi: 10.3389/fneur.2025.1623598. eCollection 2025.
In this study, we aimed to analyze the pathogen detection results in spinal infections using percutaneous CT-guided biopsy or transforaminal endoscopic spinal biopsy.
This is a retrospective observational study of patients who underwent biopsy for spinal infection at Shanghai Sixth People's Hospital between December 2020 and June 2024. Data on demographics, clinical presentations, radiological findings, and histopathology were collected from medical records. Pathogen detection results from different sampling methods were evaluated.
A total of 131 cases of spinal infection were included in the study. The average age of the patients was 59.1 ± 13.8 years. The median time from symptom onset to diagnosis was 2 months [inter-quartile range (IQR): 1 to 4.5 months]. Clinical manifestations included pain (100%) and fever (15.27%), with the lumbar vertebra being the most commonly affected site (110/168, 65.48%). Elevated ESR, CRP, and IL-6 levels were observed in most cases. MR showed high sensitivity (90.90%) but low specificity (2.04%). Pathogen detection was performed using next-generation sequencing (mNGS) and/or microbial culture. Of the 131 patients, 66 underwent percutaneous CT-guided biopsy, and 65 underwent transforaminal endoscopic spinal biopsy. All samples were tested using mNGS, while microbial culture was performed only on abscess samples from CT-guided biopsy cases. The most commonly identified pathogens were (18.9), Staphylococcus (17.9), and Streptococcus (10.5). The positive detection rates using mNGS were 51.52% for percutaneous CT-guided biopsy and 50.77% for transforaminal endoscopic biopsy, whereas the culture-positive rates were 41.67 and 42.86% on abscess samples, respectively. There is no significant difference in the positive rates between the two biopsy techniques ( = 0.007292, = 0.9319). But the detection rate of Mycobacterium under CT-guided biopsy is higher (18.18% vs. 9.23%).
Accurate pathogen diagnosis is crucial for the diagnosis and treatment of spinal infections. The microbiological detection rates of samples obtained via percutaneous CT-guided are similar to those obtained through transforaminal endoscopic spinal biopsy.
在本研究中，我们旨在分析经皮CT引导下活检或经椎间孔内镜脊柱活检在脊柱感染中的病原体检测结果。
这是一项对2020年12月至2024年6月期间在上海第六人民医院接受脊柱感染活检患者的回顾性观察研究。从病历中收集人口统计学、临床表现、影像学检查结果和组织病理学数据。评估不同采样方法的病原体检测结果。
本研究共纳入131例脊柱感染患者。患者的平均年龄为59.1±13.8岁。从症状出现到诊断的中位时间为2个月[四分位间距（IQR）：1至4.5个月]。临床表现包括疼痛（100%）和发热（任15.27%），腰椎是最常受累的部位（110/168，65.48%）。大多数病例观察到血沉、C反应蛋白和白细胞介素-6水平升高。磁共振成像显示敏感性高（90.90%）但特异性低（2.04%）。使用二代测序（mNGS）和/或微生物培养进行病原体检测。131例患者中，66例接受了经皮CT引导下活检，65例接受了经椎间孔内镜脊柱活检。所有样本均使用mNGS检测，而微生物培养仅在CT引导下活检病例的脓肿样本上进行。最常鉴定出的病原体是（18.9）、葡萄球菌（17.9）和链球菌（10.5）。经皮CT引导下活检使用mNGS的阳性检出率为51.52%，经椎间孔内镜活检为50.77%，而脓肿样本的培养阳性率分别为41.67%和42.86%。两种活检技术的阳性率无显著差异（=0.007292，=0.9319）。但CT引导下活检中分枝杆菌的检出率更高（18.18%对9.23%）。
准确的病原体诊断对于脊柱感染的诊断和治疗至关重要。经皮CT引导获取的样本的微生物检测率与经椎间孔内镜脊柱活检获取的样本相似。
