Diagnostic utility of metagenomic next-generation sequencing for determining the etiology of thoracolumbar spine infections.

OBJECTIVE

This study evaluated the diagnostic performance of metagenomic next-generation sequencing (mNGS) in identifying the etiological agents of thoracolumbar spine infections and examined its clinical relevance in facilitating timely diagnosis and therapeutic decision-making.

METHODS

A total of 54 patients with suspected thoracolumbar spinal infection admitted to the Department of Spinal Orthopedics between June 1, 2022, and January 15, 2026, were enrolled. Tissue specimens from all patients underwent microbial culture, histopathological examination, and metagenomic next-generation sequencing (mNGS). Based on established clinical diagnostic criteria, patients were classified into an infection group (n = 49) and a non-infection group (n = 5). The pathogen detection rate, and diagnostic sensitivity of mNGS and conventional culture were compared using the paired χ² test.

RESULTS

Among the 54 patients with suspected thoracolumbar spine infection, the male-to-female ratio was 2:1. The overall positive detection rate of mNGS was 75.9% (41/54), which was significantly higher than that of microbial culture at 57.4% (31/54) (χ² = 4.500, p < 0.05). When clinical diagnosis served as the reference standard, mNGS demonstrated greater sensitivity for diagnosing thoracolumbar spinal infections compared to microbial culture (83.7% vs. 63.3%), and this difference reached statistical significance (χ² = 4.500, p < 0.05).

CONCLUSION

mNGS shows a high pathogen detection rate and superior sensitivity for diagnosing thoracolumbar spinal infection, providing valuable support for clinical diagnosis and guiding therapeutic management in suspected cases.