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The MSI-20 Score Provides Reproducible Mortality Risk Stratification in Spinal Infection: A Multicenter Registry
Sara Lener1, Raphael Gmeiner2, Anto Abramovic2
1Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria. sara.lener@i-med.ac.at.
Neurospine
|August 7, 2026
Summary
The Mortality in Spinal Infection (MSI-20) score shows fair accuracy in predicting mortality for spinal infections. This validation confirms its generalizability and usefulness in clinical decision-making for patients with spinal infection.
Area of Science:
- Spinal infection research
- Prognostic tool validation
- Medical risk stratification
Background:
- Spinal infection (SI) presents significant morbidity and mortality risks.
- Optimal treatment strategies for SI, especially in fragile patients, require further definition.
- The Mortality in Spinal Infection (MSI-20) score was developed for mortality risk estimation but lacked external validation.
Purpose of the Study:
- To externally validate the MSI-20 score in a large, multicenter registry cohort.
- To assess the MSI-20 score's performance, identify optimal clinical thresholds, and evaluate its generalizability.
- To explore additional baseline predictors for mortality in spinal infection.
Main Methods:
- Retrospective analysis of 1,122 adult patients with confirmed SI from 6 tertiary centers (2010-2023).
- Calculation of MSI-20 scores and evaluation of predictive performance using receiver operating characteristic (ROC) analysis.
- Analysis of mortality across score strata, center-wise performance, and exploratory assessment of additional predictors.
Main Results:
- Overall mortality was 18.3% in the cohort (mean age 66.4 years).
- The MSI-20 demonstrated fair discriminative ability (AUC 0.68), with consistent performance across centers (AUC 0.60-0.75).
- Mortality increased with higher MSI-20 scores, reaching 47.4% for scores ≥9; no additional strong predictors were identified.
Conclusions:
- This study provides the first external validation of the MSI-20 score, confirming its reproducibility and generalizability.
- The MSI-20 score exhibits fair discrimination and a clear mortality risk gradient.
- The MSI-20 score can serve as a valuable adjunctive tool for risk communication and patient management in spinal infection.