Vertebral osteomyelitis: a comparative, single-center study in northwestern China

Vertebral osteomyelitis (VO) is an infection of the spine with increasing prevalence due to improved diagnostics and aging populations. Multiple pathogens, including Mycobacterium tuberculosis, Brucella spp., and pyogenic bacteria, can cause VO, making differential diagnosis complex, especially in regions with endemic brucellosis and tuberculosis. Early and accurate diagnosis is essential for appropriate treatment.

This was a single-center, retrospective, observational study performed between 2019 and 2022 in Kashi, Xinjiang.

In this study, a total of 319 patients were enrolled, comprising 45.5% with tuberculous vertebral osteomyelitis (TVO; 52.4% females), 37.9% with brucellar vertebral osteomyelitis (BVO; 19.8% females), and 16.6% with pyogenic vertebral osteomyelitis (PVO; 52.8% females). Demographically, TVO had a longer mean time to diagnosis compared to BVO and PVO. BVO was more prevalent in male, and PVO patients had higher rates of spinal surgery history (45.3%) and diabetes (13.2%). Clinically, TVO patients presented with fever (72.4%), sweating (83.4%), weight loss (71.7%), and appetite loss (84.8%) more frequently, while BVO patients reported more lower back pain (86.0%). Laboratory investigations revealed significantly higher leucocyte and neutrophil levels in PVO, whereas TVO patients had elevated monocyte-to-lymphocyte and platelet-to-lymphocyte ratios. Radiologically, TVO patients exhibited a higher incidence of thoracic involvement (56.6%) and skip lesions (20%). Microbiologically, BVO and PVO had high positive culture rates (84.3 and 84.9%, respectively), with M. tuberculosis isolated from only 4.1% of TVO patients.

These findings underscore the distinct clinical, laboratory, and radiological characteristics of TVO, BVO, and PVO.