Objective To explore the application value of metagenomic next-generation sequencing (mNGS) technology in the diagnosis of spinal tuberculosis.

Methods A total of 129 patients with suspected spinal tuberculosis admitted from January 2021 to January 2023 were selected as study subjects. Lesion tissue samples were collected intraoperatively and subjected to conventional microbiological testing (CMT), Mycobacterium tuberculosis DNA (MTB-DNA) amplification testing, and mNGS testing. The diagnostic efficacy of different testing methods was compared using results of comprehensive clinical diagnosis as the gold standard.

Results Among 129 patients, 101 (78.29%) were confirmed to have spinal tuberculosis, and 28 (21.71%) had other spinal infections. Using clinical results as the diagnostic gold standard, the sensitivity of mNGS was 94.06% (95/101), and specificity was 89.29% (25/28); the sensitivity of MTB-DNA amplification was 90.10% (91/101), and specificity was 89.29% (25/28); the sensitivity of CMT was 86.14% (87/101), and specificity was 85.71% (24/28). Compared with MTB-DNA amplification and CMT, mNGS showed the highest consistency with clinical results, and its consistency in detecting different lesion sites was also optimal, with statistically significant differences (P < 0.05).

Conclusion mNGS testing has high diagnostic value for spinal tuberculosis and can provide a reference for clinical diagnosis, thereby guiding clinical decision-making.