Clinical, laboratory, and MRI features differentiating tuberculous and pyogenic spondylodiscitis: a propensity score–matched analysis

Differentiating tuberculous spondylodiscitis (TS) from pyogenic spondylodiscitis (PS) is challenging due to overlapping clinical and radiological features. Early and accurate diagnosis is crucial for appropriate management. This study aimed to identify clinical, laboratory, and MRI parameters that may assist in the early differentiation of TS from PS. This retrospective study included 76 adult patients diagnosed with TS (n = 21) or PS (n = 55) between January 2023 and July 2025. Clinical, laboratory, and MRI findings were compared between groups. To reduce selection bias, propensity score matching (PSM) was applied based on age, sex, and comorbidities. Variables showing significant differences in univariate analyses were entered into a multivariate logistic regression model to determine independent predictors of TS. Before and after PSM, the symptom duration was significantly longer in TS. Inflammatory markers (WBC, neutrophil count, ESR, and CRP) were higher in patients with PS. MRI revealed that thoracic involvement and vertebral body destruction greater than 50% were significantly associated with TS both before and after PSM and remained independent predictors in multivariate analysis (p = 0.048 and p = 0.013, respectively). Thoracic vertebral involvement and vertebral destruction exceeding 50% are independent predictors of tuberculous spondylodiscitis, providing valuable guidance for early and accurate differentiation from pyogenic infection.