Development and Validation of a Novel Diagnostic Nomogram to Differentiate Between Spinal Tuberculosis and Pyogenic Spinal Infection

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Abstract

Background: Differentiating spinal tuberculosis (STB) from pyogenic spinal infection (PSI) remains a critical diagnostic challenge, and misdiagnosis can lead to inappropriate treatment, prolonged morbidity, and poor clinical outcome. Objective: This study aims to develop a convenient, practical model on the basis of routinely available clinical data to accurately differentiate between STB and PSI. Patients and Methods: We retrospectively reviewed 211 patients (59 STB, 152 PSI) with pathological confirmation in our hospital’s orthopedic department, collecting general data (age, gender, BMI, tuberculosis history), laboratory indices (T-SPOT.TB, white blood cell, NP, C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], hemoglobin, etc.), and imaging findings (intervertebral disc destruction [IDD], vertebral body destruction [VBD], sclerotic bone and sequestrum formation [SBSF], intraspinal abscess [ITA], injection abscess). Univariate and multivariate regressions identified independent factors to construct a nomogram, whose performance was assessed via receiver operating characteristic curves, calibration curves, and decision curve analysis. Results: Univariate analysis revealed that the T-SPOT.TB, CRP, ESR, albumin, albumin-to-globulin ratio, IDD, VBD, SBSF, and ITA were statistically significant. Multifactorial logistic regression analysis revealed that the T-SPOT. TB, CRP, ESR, and albumin were strongly associated with STB. The nomogram model was established via R software on the basis of risk factors. The area under the receiver operating characteristic of the subjects in the modeling group was 0.770. According to the nomogram model, the predicted value of the calibration curve was consistent with the actual value. Conclusion: This nomogram provides a reliable, simple, economical, practical tool for differentiating STB from PSI. By enabling accurate and timely distinction between these two infectious entities, the model facilitates the development of targeted and more effective treatment strategies.