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METHODS article

Front. Neurol.

Sec. Neuroinfectious Diseases

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1623598

Percutaneous CT-guided or Endoscopic Spinal Biopsy with Accurate Pathogen Detection for Spinal Infection

Provisionally accepted
Jinmei  ChenJinmei Chen1*Qingxin  GuoQingxin Guo1Xiaohua  ChenXiaohua Chen1*Luying  TianLuying Tian1Leer  ShenLeer Shen1Yi  ZhangYi Zhang1Qiong  JiaoQiong Jiao2Xiao-Feng  LianXiao-Feng Lian3*
  • 1Department of Infectious Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 2Department of Pathology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 3Department of Orthopedics, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

The final, formatted version of the article will be published soon.

Aims:In this study, we aimed to analyze the pathogen detection results in spinal infections using percutaneous CT-guided biopsy or transforaminal endoscopic spinal biopsy.Methods: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. Datas on demographics, clinical presentations, radiological findings and histopathology were collected from medical records. Pathogen detection results from different sampling methods were evaluated.Results: 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) 1to 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 Mycobacterium tuberculosis (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 (X 2 =0.007292,P=0.9319). But the detection rate of Mycobacterium under CT-guided biopsy is higher (18.18% vs. 9.23%).infections. The microbiological detection rates of samples obtained via percutaneous CT-guided are similar to those obtained through transforaminal endoscopic spinal biopsy.

Keywords: Transforaminal endoscopic spinal biopsy, pathogen, Next-generation sequencing, Spinal infection, Percutaneous CT-guided biopsy

Received: 05 Jun 2025; Accepted: 01 Aug 2025.

Copyright: © 2025 Chen, Guo, Chen, Tian, Shen, Zhang, Jiao and Lian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Jinmei Chen, Department of Infectious Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
Xiaohua Chen, Department of Infectious Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
Xiao-Feng Lian, Department of Orthopedics, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

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