AO Spine Clinical Practice Recommendations for the Management of Spinal Tuberculosis

Study design Literature review with clinical recommendations. Objective To highlight impactful studies on the management of spinal tuberculosis (STB), identified by the AO Spine Knowledge Forum Trauma and Infection group, with recommendations for their integration into clinical practice. Methods Four studies addressing key phases of STB management — imaging diagnosis, laboratory diagnosis, surgical indication and approach, and imaging-based healed status — were reviewed. Consensus recommendations of the KF opinion leaders were graded as strong or conditional following the GRADE methodology. Results Altini et al evaluated the diagnostic value of MRI and FDG-PET/CT in spondylodiscitis including STB; we conditionally recommend FDG-PET/CT as an adjunctive imaging modality when MRI is inconclusive, contraindicated, or limited by artifact. Hu et al developed a multivariable laboratory prediction model based on seven routine indices for early STB diagnosis, achieving an AUC of 0.947; we conditionally recommend this model as an adjunctive screening tool when definitive microbiological testing is delayed or unavailable. Tang et al compared anterior-only, posterior-only, and combined surgical approaches in thoracolumbar STB; we conditionally recommend a posterior-only approach as the preferred surgical strategy in most cases requiring operative treatment. Mittal et al evaluated FDG-PET/CT and contrast MRI for defining healed status and guiding treatment completion; we conditionally recommend FDG-PET/CT as an adjunctive tool when the treatment endpoint remains uncertain or MRI is limited by metallic implants. Conclusion This review provides spine surgeons and clinicians with evidence-based, expert-graded recommendations to enhance standardization and effectiveness across the key clinical decision points in spinal tuberculosis management.