Objective The aim is to study the diagnostic positive rates of metagenomic next-generation sequencing (mNGS), microbial culture, and serologic testing in suspected native spinal brucellosis, and to evaluate the clinical value of their combined application.
Methods In this multicenter, retrospective observational study, 128 patients with suspected native spinal brucellosis from 6 medical centers (February 2020 to February 2025) were enrolled. Specimens from infection sites were subjected to microbial culture, mNGS, and serological testing (agglutination test).
Results Of the 128 patients with suspected native spinal Brucella infections, 118 patients were diagnosed with Brucella spondylitis. Among the 118 confirmed Brucella spondylitis cases, mNGS demonstrated a positivity rate of 92.37% (109 of 118), significantly higher than that of culture (26.27%, 31 of 118) and agglutination test (83.05%, 98 of 118). In the 87 culture-negative samples, mNGS detected Brucella in 91.95% (80 of 87), compared to 82.76% (72 of 87) by agglutination test. mNGS confirmed Brucella infection in all 16 cases that were agglutination test negative. mNGS combined with agglutination tests can effectively complement each other, improving the sensitivity of diagnosis and thereby minimizing missed diagnoses to the greatest extent. Among the 10 nonbrucellar spinal pathologies, agglutination test showed a high false-positive rate of 90% (9 of 10), whereas mNGS had a 10% (1 of 10) false-positive rate. Therefore, the agglutination test has a relatively high rate of false positives.
Conclusion mNGS detection represents an effective adjunct to microbial culture and the agglutination test. The concurrent use of all 3 methods enhances diagnostic accuracy and reduces the likelihood of missed and incorrect diagnoses, significantly improving patient prognosis and guiding personalized clinical treatment.
Objective To explore a surgical technique for completing ventral bone decompression and C1–2 plate-screw fixation in the craniocervical junction (CVJ) through nasal approach by stage I at the imaging and physical anatomy levels, and to evaluate its feasibility.
Methods Radiographic parameters of 80 patients with basilar invagination (BI) and 56 with normal CVJ anatomy were retrospectively analyzed. Three-dimensional (3D) reconstructions were performed in 31 patients with BI. Key anatomical landmarks, screw entry points, and fixation trajectories were evaluated. Customized plate-screw constructs were designed. Finally, surgical feasibility was tested on a 3D-printed anatomical model and a cadaveric.
Results In 80 BI patients, the average distances between 4 screw insertion points were 16.04 mm, 21.10 mm, 6.83 mm, and 7.10 mm. C2 lateral mass oblique lengths were 16.81 mm (right) and 17.12 mm (left); C1 lengths were 18.71 mm (right) and 19.07 mm (left), with significant differences between C1 and C2 (p<0.001). A 28.5×14.1-mm titanium plate with 16 mm screws was successfully implanted via the nasal route in the polyether ether ketone 3D-printed BI model and the cadaveric. Radiology indicated that the screws were all in the lateral mass and the plates fit tightly.
Conclusion In BI, transnasal odontoidectomy and plate-screw fixation of C1–2 are feasible theoretically. This may enable a new alternative approach for nasal minimally invasive decompression and immobilization, following the completion of biomechanics and clinical trials.
Objective To compare the long-term clinical and radiographic outcomes of transforaminal endoscopic lumbar discectomy (TELD) versus microdiscectomy (MD).
Methods The data of 154 patients with lumbar disc herniation (LDH) who underwent TELD (n = 89) or MD (n = 65) were retrospectively analyzed. The patients’ clinical outcomes were evaluated using visual analogue scales for leg and low back pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI). The evolution of radiographic manifestations was observed during follow-up. Potential risk factors for a poor clinical outcome were investigated.
Results During a mean follow-up of 5.5 years (range, 5–7 years), the recurrence rate was 4.49% in the TELD group and 1.54% in the MD group. All scores significantly improved from preoperatively to postoperatively in both groups (p < 0.01). The improvement in the ODI and JOA scores was significantly greater in the TELD than MD group (p < 0.05). Forty-seven patients (52.8%) in the TELD group and 32 (49.2%) in the MD group had Modic changes before surgery, most of which showed no changes at the last follow-up. The degeneration grades of 292 discs (71.0%) were unchanged at the last follow-up, while 86 (20.9%) showed improvement, mostly at the upper adjacent segment. No significant difference was observed in the intervertebral height index or paraspinal muscle-disc ratio.
Conclusion Both TELD and MD provide generally satisfactory long-term clinical outcomes for patients with LDH. TELD can be used as a reliable alternative to MD with less surgical trauma. Modic type II changes, decreased preoperative intervertebral height, and a high body mass index are predictors of a poor prognosis.
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