Evidence map›Paper›PMID 42086793›Full record

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

Development and validation of a nomogram for differential diagnosis of pyogenic spondylitis and tuberculous spondylitis in China: a multicenter retrospective study.

Liang Xu, Enuo Dai, Lulu Shi, Yongrui Yang, Wenkai Ruan, Jianlong Li, Rongpan Dang, Huigang An, Wentao Zhao, Yingxin Zhao and 13 more

Abstract readMulticenter StudyValidation Study
PubMed Publisher
In one paragraph

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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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

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4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

23 authors.

Liang XuDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Enuo DaiDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Lulu ShiDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Yongrui YangDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Wenkai RuanDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Jianlong LiDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Rongpan DangDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Huigang AnDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Wentao ZhaoDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Yingxin ZhaoDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Zhaofei LiDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Chenggui ZhangDepartment of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Chenguang JiaDepartment of Orthopedics, Hebei Chest Hospital, Shijiazhuang, China.
Zhongji WangDepartment of Orthopedics, Jilin Provincial Tuberculosis Hospital (Jilin Provincial Infectious Disease Hospital), Changchun, China.
Qile GaoDepartment of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.
Ningkui NiuDepartment of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China.
Shangsheng XuDepartment of Orthopedics, The 4th People's Hospital of Qinghai Province, Xining, China.
Rui BaoDepartment of Orthopedics, Guiyang Public Health Treatment Center, Guiyang, China.
Zhigang HuangDepartment of Orthopedics, Shenzhen Third People's Hospital, Shenzhen, China.
Zhaopeng LiDepartment of Orthopedics, The Fourth Hospital of Heilongjiang Province, Harbin, China.
Xiaogang GuanDepartment of Orthopedics, Taiyuan Fourth People's Hospital, Taiyuan, China.
Shengping HuDepartment of Orthopedics, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou, China.
Hongdong TanDepartment of Orthopedics, Shandong Public Health Clinical Center, Shandong University, Jinan, China. Tanhd_1218@163.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPyogenic spondylitis (PS) and tuberculous spondylitis (TS) present with significant clinical overlap, posing a major diagnostic challenge. We aimed to develop and validate an imaging-based nomogram integrating CT and MRI features to accurately differentiate PS from TS.

methodWe conducted a multicenter retrospective study including 539 patients with spinal infections (251 PS, 288 TS) diagnosed between June 2021 and May 2025. Patients were divided into training (n = 427) and external validation (n = 112) cohorts. Imaging features were screened using univariate logistic regression. The least absolute shrinkage and selection operator (LASSO) regression was then applied to select the optimal predictive feature subset and mitigate overfitting. A multivariate logistic regression model based on these features constructed the nomogram. We evaluated diagnostic performance using the area under receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Internal validation employed 500 bootstrap resamples; external validation used an independent cohort.

resultsThe training cohort comprised 187 (43.8%) PS and 240 (56.2%) TS patients; the external validation cohort had 64 (57.1%) PS and 48 (42.9%) TS patients. LASSO regression identified five key predictors: vertebral involvement pattern (continuous vs. skip/non-continuous), vertebral body T2-weighted signal intensity (hyperintense vs. heterogeneous), MRI abscess wall characteristics (thick/irregular vs. thin/smooth), CT bone destruction type (osteolytic vs. fragmentary), and CT sagittal bone destruction degree (< 1/3 vs. > 2/3). The AUCs of the nomograms for the training and external validation cohorts were 0.908 (95% confidence interval: 0.880-0.936) and 0.899 (95% confidence interval: 0.842-0.955), respectively. Calibration curves showed the optimal concordance between predicted results and the actual observations. DCA indicated that the substantial clinical net benefit across threshold probabilities.

conclusionThe developed nomogram is capable of accurately distinguishing between PS and TS, thereby aiding clinicians in making informed decisions promptly upon obtaining relevant data.

Indexed as

NomogramsSpondylitisTuberculosis, SpinalAdultAgedChinaDiagnosis, DifferentialFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedRetrospective StudiesTomography, X-Ray ComputedComputed tomographyMagnetic resonance imagingNomogramPyogenic spondylitisTuberculous spondylitis

Identifiers

PMID42086793

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.