Work

Development and validation of a predictive nomogram for surgical intervention in patients with spondylodiscitis

Year: 2026

Type: article

Abstract: Spondylodiscitis often presents with complex clinical courses, and a subset of patients require surgical intervention due to neurological deficits, structural instability, or failed medical therapy. Identifying high-risk patients early remains challenging, and no widely accepted predictive model exists to guide surgical decision-making. This study aimed to develop and validate a nomogram for predicting the need for surgery in Spondylodiscitis patients. This retrospective study enrolled 223 patients with spondylodiscitis who were admitted to the Spine Infection Surgery Department of Public Health Clinical Center affiliated to Shandong University between September 2023 and September 2025. Relevant clinical, laboratory, and microbiological data were collected from these cases. LASSO regression and univariate logistic regression analyses were applied to identify the most relevant diagnostic predictors. A nomogram was then developed based on the selected variables. The diagnostic performance and clinical utility of the nomogram were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Eight variables were selected to construct a nomogram for surgical intervention in spondylodiscitis, including neurological impairment, epidural abscess, osteoporosis, the degree of sagittal bone destruction, localized kyphosis, interleukin-6 (IL-6), plasma fibrinogen and platelet. The predictive model yielded an AUC of 0.907 (95% CI, 0.861–0.952), and in the internal validation, the AUC was 0.910 (95% CI, 0.850–0.940). The predictive model was well-calibrated, and DCA showed that if the threshold probability of surgical intervention was between 3% and 96%, using the proposed nomogram to predict surgical intervention in spondylodiscitis would obtain a net benefit. The proposed nomogram effectively predicts the likelihood of surgical intervention in spondylodiscitis patients using readily available clinical parameters. This tool may assist clinicians in identifying patients with a high probability of requiring surgery, thereby facilitating timely surgical evaluation and potentially improving outcomes. Not applicable.

Source: BMC Musculoskeletal Disorders

DOI: 10.1186/s12891-026-10625-2