Background Tuberculous spinal infection is a difficult disease in spinal surgery, and most of its early clinical symptoms are atypical, and the specificity of laboratory tests, imaging tests and histopathologic examinations is not high. Pathogenetic diagnosis is the gold standard for the diagnosis of tuberculous spinal infection, but the culture of pathogenic microorganisms has the disadvantages of long period and low positive rate. Metagenomic next-generation sequencing technology is currently used in clinical diagnosis, but there are fewer relevant literature reports on the comparison between mNGS and other common clinical detection methods. Objective To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) technology for tuberculous spinal infection disease.
Methods Patients who were admitted to the Department of Spine Surgery of the Eighth Medical Center of Chinese PLA General Hospital and diagnosed as spine infection from February 2021 to September 2023 were included in this study. Specimens of blood, pus, and lesion tissue were collected for serological testing, bacterial culture, tuberculosis culture, pathological examination, X-pert, and mNGS testing, and the results were compared with clinical diagnosis (gold standard). The diagnostic value of different detection methods was analyzed.
Results There were 68 males and 44 females included in this study, with age ranged from 14 years to 87 years (58.98 ± 13.70 years). The clinical diagnosis revealed 63 cases of non-tuberculous spinal infection and 49 cases of spinal tuberculosis infection. mNGS detected positive results for spinal infection in 90 cases (80.4%), while microbial culture detected positive results in 51 cases (45.5%). In terms of determining tuberculosis infection in spinal infections, mNGS detected positive results in 34 cases (69.39%), while microbial culture detected positive results in only 17 cases (34.69%). Among the clinical diagnostic efficacy analysis results of mNGS, microbial culture, T-spot, and X-pert for spinal tuberculosis, mNGS showed the highest efficacy (AUC=0.839) with the highest accuracy in diagnosis, surpassing currently used clinical methods. The combined diagnostic approach of mNGS and the four methods showed the highest diagnostic efficacy, with ROC-AUC (95% CI) values of 0.846 (0.701-0.971) and 0.876 (0.773-0.962) respectively, significantly higher than the other three individual methods, with a Delong test P<0.05.
Conclusion mNGS enables rapid and efficient detection of pathogenic microorganisms in infectious diseases of the spine, and it has a high detection rate, sensitivity, and specificity for tuberculous spinal infections. This technology is a good and fast method for diagnosing and differentiating infectious diseases of the spine, providing guidance for the diagnosis of tuberculous spinal infections.
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