Clinical outcomes of a standardized diagnostic and treatment pathway for native spinal infections: a retrospective study

To evaluate the clinical feasibility and outcomes of a standardized diagnostic–therapeutic pathway incorporating rapid pathogen identification and stepwise surgical decision-making in patients with native spinal infections. We retrospectively reviewed 175 consecutive patients with native spinal infections managed at a tertiary referral center. The standardized pathway included structured admission assessment, minimally invasive diagnostic procedures, combined metagenomic next-generation sequencing (mNGS) and conventional culture for pathogen identification, and a stepwise escalation strategy for surgical and interventional management based on spinal stability and neurological status. Clinical outcomes were evaluated in terms of changes in inflammatory markers, pain relief, and neurological recovery. A causative pathogen was identified in 124 patients (70.9%) using the combined diagnostic yield of either mNGS or culture, with results typically available within one week. Minimally invasive procedures were performed in 72 patients (41.1%), while 49 patients (28.0%) required open surgery due to spinal instability or significant neural compression. Inflammatory markers significantly improved during follow-up, with substantial reductions in CRP and ESR levels. Pain improved substantially, with mean visual analog scale scores decreasing from 7.6 to 3.1 ( P < 0.01). Among 68 patients with neurological deficits, 46 (67.6%) demonstrated improvement of at least one Frankel grade, with no cases of deterioration. Complications were infrequent, and no recurrence was observed during follow-up. A standardized diagnostic–therapeutic pathway integrating rapid pathogen detection and stepwise surgical decision-making is feasible and associated with favorable clinical and neurological outcomes in native spinal infections. This approach may provide a practical framework for structured diagnosis, individualized treatment decision-making, and comprehensive clinical management of native spinal infections.