ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Metagenomic next-generation sequencing for the diagnosis of suspected spinal infections from biopsy samples: a novel biopsy toolkit design and real-life diagnostic value.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo introduce a novel fluoroscopy-guided intervertebral disc biopsy toolkit and assess the real-life clinical utility of metagenomic next-generation sequencing (mNGS) in antibiotic decision-making for suspected spinal infections. The microbial yield of soft tissues (intervertebral discs, paraspinal or psoas abscesses) was reported higher than that of bone tissues in pyogenic spondylodiscitis patients undergoing needle biopsy. However, no standardized, minimally invasive method exists for repeated solid-disc tissue retrieval with active debridement. Besides, limited data concerning the real-life value of mNGS for biopsy samples in antibiotic decision-making are available. MATERIALS AND
methodsEighty-four patients with suspected spinal infection underwent biopsy using the new toolkit (disc-targeted n=48, transpedicular vertebral n=36). All samples were submitted for conventional microbiological tests (CMT, including blood/biopsy cultures, acid-fast bacilli (AFB) staining, Xpert MTB/RIF assay, Brucella tube agglutination test, and galactomannan antigen (GM) testing) and mNGS. Diagnostic yield, pathogen spectrum, and treatment success rates (TSR) under different antibiotic strategies were compared.
resultsEighty-four patients with suspected spinal infections met the inclusion criteria. The culture positive rate from intervertebral discs was greater than that from vertebral bodies (50.0% vs. 27.8%, p =0.046). The positivity rate detected by mNGS was significantly greater than that identified by CMT (91.7% vs.54.8%, p < 0.001). The 14-day treatment success rate (TSR14d) of patients treated with mNGS-guided antibiotics (72.5%) was significantly greater than that without mNGS-guided antibiotics (33.3%) (p=0.020). mNGS showed great potential for enhancing antibiotic stewardship in most patients, especially in the early stage after admission.
conclusionThe novel trans-Kambin’s triangle biopsy toolkit significantly improves culture yield from intervertebral discs. When combined with mNGS, it enables precise pathogen identification and enhances early antibiotic stewardship in suspected spinal infections.
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