Research progress on influencing factors and management strategies of medical delay in patients with spinal tuberculosis

doi:10.19982/j.issn.1000-6621.20260124

Abstract

Abstract:

Spinal tuberculosis (STB), a major form of osteoarticular tuberculosis, has become a significant concern in both clinical and public health domains due to its insidious onset, diagnostic challenges, and high risk of disability. In recent years, delayed medical consultation among STB patients has become increasingly prominent, with an average total delay of 4 to 11 months. This paper summarizes and analyzes the current status, influencing factors, and management strategies related to consultation delay in STB, aiming to inform evidence-based interventions for reducing disability, improving patient outcomes, and formulating scientific countermeasures. Future efforts should focus on strengthening public health education, improving the health insurance system, raising diagnostic alertness among primary care physicians, optimizing diagnostic technologies, and establishing comprehensive, individualized treatment plans.

Key words: Tuberculosis, spinal, Medical delay, Risk factors, Health services administration

CLC Number:

Yang Yueqi, Fu Linlin, He Lanfang, Cao Yuanlin, Yu Sihan, Zhang Yingfang, Xia Tongxia. Research progress on influencing factors and management strategies of medical delay in patients with spinal tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(8): 1226-1230. doi: 10.19982/j.issn.1000-6621.20260124

References 51

[1]	屈燕, 李涛, 马文斌, 等. 世界卫生组织《2025年全球结核病报告》解读[J]. 结核与肺部疾病杂志, 2025, 6(6): 613-623. doi:10.19983/j.issn.2096-8493.20250178.
[2]	Na S, Lyu Z, Zhang S. Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions[J]. Orthop Surg, 2023, 15(6):1454-1467. doi:10.1111/os.13744.
[3]	Kehayov I I, Davarski A N, Slavov G S, et al. Tuberculous Spondylodiscitis: A Report of Two Cases and Literature Review[J]. Cureus, 2025, 17(6): e85235. doi:10.7759/cureus.85235.
[4]	Kumar V, Neradi D, Sherry B, et al. Tuberculosis of the spine and drug resistance: a review article[J]. Neurosurg Rev, 2022, 45(1): 217-229. doi:10.1007/s10143-021-01595-1.
[5]	《脊柱结核并发HIV/AIDS患者诊断及治疗专家共识》编写组, 中国防痨协会骨关节结核专业分会, 中国性病艾滋病防治协会艾滋病外科专业委员会, 等. 脊柱结核并发HIV/AIDS患者诊断及治疗专家共识(第2版)[J]. 中国防痨杂志, 2025, 47(1): 1-11. doi:10.19982/j.issn.1000-6621.20240411.
[6]	张诚, 刘汝银, 杨开泰, 等. 中药治疗耐药性脊柱结核的研究进展[J]. 颈腰痛杂志, 2025, 46(1): 191-196. doi:10.3969/j.issn.1005-7234.2025.01.035.
[7]	Xue D, Chen X, Shao L, et al. Risk factors for the progression from pulmonary tuberculosis to spinal tuberculosis: a logistic regression analysis[J]. J Orthop Surg Res, 2025, 20(1): 422. doi:10.1186/s13018-025-05848-3. pmid: 40296147
[8]	Chen L, Liu C, Liang T, et al. Monocyte-to-Lymphocyte Ratio Was an Independent Factor of the Severity of Spinal Tuberculosis[J]. Oxid Med Cell Longev, 2022, 2022: 7340330. doi:10.1155/2022/7340330.
[9]	Williams P, Rebeiz M C, Hojeij L, et al. Help-seeking behaviour in women diagnosed with gynaecological cancer: a systematic review[J]. Br J Gen Pract, 2022, 72(725): e849-e856. doi:10.3399/BJGP.2022.0071.
[10]	Duan Y, Sun M, Cheng C, et al. Tuberculosis patients’ delay in healthcare access and its associated factors in Shandong Province, China[J]. BMC Public Health, 2025, 25(1): 3729. doi:10.1186/s12889-025-25090-0.
[11]	Teo A K J, Singh S R, Prem K, et al. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis[J]. Respir Res, 2021, 22(1): 251. doi:10.1186/s12931-021-01841-6.
[12]	Vogiatzoglou A, Mitrova M H, Papadaki E, et al. Bone and Joint Tuberculosis: The Experience From a Tuberculosis Department in Northern Greece[J]. Case Rep Infect Dis, 2025, 2025:1632733. doi:10.1155/crdi/1632733.
[13]	李静, 姜游力, 陈敬芳, 等. 结核病患者就诊延迟现状调查及影响因素分析[J]. 热带医学杂志, 2022, 22(11): 1601-1604. doi:10.3969/j.issn.1672-3619.2022.11.030.
[14]	Glassman I, Nguyen K H, Giess J, et al. Pathogenesis, Diagnostic Challenges, and Risk Factors of Pott’s Disease[J]. Clin Pract, 2023, 13(1): 155-165. doi:10.3390/clinpract13010014.
[15]	Cormican L, Hammal R, Messenger J, et al. Current difficulties in the diagnosis and management of spinal tuberculosis[J]. Postgrad Med J, 2006, 82(963): 46-51. doi:10.1136/pgmj.2005.032862. pmid: 16397080
[16]	Diomandé M, Coulibaly Y, Goua J J, et al. Pott’s disease in Abidjan: experience of the department of rheumatology of university teaching hospital of Cocody: about 420 cases[J]. Tunis Med, 2023, 101(1): 19-25.
[17]	单文翰. 西藏地区某医院脊柱结核流行病学及临床特点分析[D]. 拉萨: 西藏大学, 2025.
[18]	Liu Z, Wang J, Chen G Z, et al. Clinical Characteristics of 1378 Inpatients with Spinal Tuberculosis in General Hospitals in South-Central China[J]. Biomed Res Int, 2019, 2019: 9765253. doi:10.1155/2019/9765253.
[19]	Wang P, Liao W, Cao G, et al. Characteristics and Management of Spinal Tuberculosis in Tuberculosis Endemic Area of Guizhou Province: A Retrospective Study of 597 Patients in a Teaching Hospital[J]. Biomed Res Int, 2020, 2020: 1468457. doi:10.1155/2020/1468457.
[20]	Leowattana W, Leowattana P, Leowattana T. Tuberculosis of the spine[J]. World J Orthop, 2023, 14(5): 275-293. doi:10.5312/wjo.v14.i5.275. pmid: 37304201
[21]	Yuan Y, Li P, Qiu X, et al. Bone and joint tuberculosis: clinical manifestation, diagnostic techniques and drug resis-tance analysis[J]. Front Cell Infect Microbiol, 2025, 15: 1687906. doi:10.3389/fcimb.2025.1687906.
[22]	Zeng H, Liang Y, He J, et al. Analysis of Clinical Characteri-stics of 556 Spinal Tuberculosis Patients in Two Tertiary Teaching Hospitals in Guangxi Province[J]. Biomed Res Int, 2021, 2021: 1344496. doi:10.1155/2021/1344496.
[23]	Ifthekar S, Ahuja K, Yadav G, et al. Sociodemographic patterns of spinal tuberculosis patients from a tertiary care teaching hospital: A 5-year cross-sectional study[J]. J West Afr Coll Surg, 2024, 14(3): 339-344. doi:10.4103/jwas.jwas_158_23.
[24]	袁劲松, 陈敬芳, 邓国防, 等. 结核病患者健康素养评估工具的研究进展[J]. 结核与肺部疾病杂志, 2026, 7(1): 120-124. doi:10.19983/j.issn.2096-8493.20250160.
[25]	吴文聪, 高敏, 陈琳, 等. 泸州市脊柱结核患者疾病认知现状与健康教育需求分析[J]. 预防医学情报杂志, 2019, 35(9): 951-954.
[26]	Shanmuganathan R, Ramachandran K, Shetty A P, et al. Active tuberculosis of spine: Current updates[J]. N Am Spine Soc J, 2023, 16: 100267. doi:10.1016/j.xnsj.2023.100267.
[27]	Garg R K, Somvanshi D S. Spinal tuberculosis: a review[J]. J Spinal Cord Med, 2011, 34(5): 440-454. doi:10.1179/2045772311Y.0000000023. pmid: 22118251
[28]	Norisyam Y, Shanmugam J T, Lim H S, et al. Successful Empirical Treatment of Suspected Spinal Tuberculosis: A Case Report[J]. Cureus, 2024, 16(3): e55562. doi:10.7759/cureus.55562.
[29]	Franco J V, Bongaerts B, Metzendorf M I, et al. Undernutrition as a risk factor for tuberculosis disease[J]. Cochrane Database Syst Rev, 2024, 6(6): CD015890. doi:10.1002/14651858.CD015890.pubz.
[30]	Ayen A A, Tebeje W T, Argaw D A, et al. Pott’s disease presenting with bilateral psoas abscesses in a resource-poor setting: Case report and literature review[J]. Int Surg Case Rep, 2025, 128: 111039. doi:10.1016/j.ijscr.2025.111039.
[31]	Liu Z, Li W, Zhang Y, et al. Analysis of Clinical Factors, Bacterial Genotyping, and Drug Resistance for Spinal Tuberculosis in South-Central China[J]. Biomed Res Int, 2020, 2020: 9871390. doi:10.1155/2020/9871390.
[32]	Li Z, Wang J, Xiu X, et al. Evaluation of different diagnostic methods for spinal tuberculosis infection[J]. BMC Infect Dis, 2023, 23(1): 695. doi:10.1186/s12879-023-08655-5. pmid: 37853312
[33]	Xiang Y, Huang C, He Y, et al. Cancer or Tuberculosis: A Comprehensive Review of the Clinical and Imaging Features in Diagnosis of the Confusing Mass[J]. Front Oncol, 2021, 11: 644150. doi:10.3389/fonc.2021.644150.
[34]	Tang L, Feng S, Gao R, et al. A Comparative Study on the Role of Xpert MTB/RIF in Testing Different Types of Spinal Tuberculosis Tissue Specimens[J]. Genet Test Mol Biomarkers, 2017, 21(12): 722-726. doi:10.1089/gtmb.2017.0149.
[35]	Gatechompol S, Sophonphan J, Kerr S J, et al. Monocyte-to-lymphocyte ratio as a predictor of TB among people living with HIV[J]. Int J Tuberc Lung Dis, 2021, 25(11): 933-938. doi:10.5588/ijtld.21.0300. pmid: 34686236
[36]	Guillouzouic A, Andrejak C, Peuchant O, et al. Treatment of Bone and Joint Tuberculosis in France: A Multicentre Retrospective Study[J]. J Clin Med, 2020, 9(8): 2529. doi:10.3390/jcm9082529.
[37]	Held M, Laubscher M, Zar H J, et al. GeneXpert polymerase chain reaction for spinal tuberculosis: an accurate and rapid diagnostic test[J]. Bone Joint J, 2014, 96-B(10): 1366-1369. doi:10.1302/0301-620X.96B10.34048. pmid: 25274923
[38]	秦世炳, 石仕元, 胡胜平, 等. 脊柱结核的诊断技术、手术时机及耐药结核的处理[J]. 中华骨科杂志, 2026, 46(1): 88-94. doi:10.3760/cma.j.cn121113-20250415-00368.
[39]	Sethy S S, Kandwal P, Verma A, et al. Defining surgical indication for instability in spinal tuberculosis: validation analysis of Tuberculosis Spine Instability Score (TSIS): a prospective observational cohort study[J]. Bone Joint J, 2025, 107-B(5): 540-547. doi:10.1302/0301-620X.107B5.BJJ-2024-1438.R1.
[40]	高永建, 欧云生, 权正学, 等. 胸腰椎脊柱结核外科治疗的研究进展[J]. 中国修复重建外科杂志, 2018, 32(1): 112-117. doi:10.7507/1002-1892.201705124.
[41]	孟婷, 陈敬芳, 邓国防, 等. 结核病患者心理脆弱及焦虑抑郁状态相关研究进展[J]. 结核与肺部疾病杂志, 2024, 5(6): 583-589. doi:10.19983/j.issn.2096-8493.2024131.
[42]	中国防痨协会骨结核专业分会, 《中国防痨杂志》编辑委员会. 加速康复外科理念在脊柱结核外科中应用的专家共识[J]. 中国防痨杂志, 2023, 45(3): 225-234. doi:10.19982/j.issn.1000-6621.20220493.
[43]	夏媛媛. 结核病患者身份与医疗救助变迁[J]. 医学与哲学, 2026, 47(1): 68-72. doi:10.12014/j.issn.1002-0772.2026.01.13.
[44]	Mekariya K, Ayutthaya P S N, Naowanirut A, et al. Diagnostic accuracy of interferon-gamma release assay and mucosal-associated invariant T cells in spinal tuberculosis[J]. Sci Rep, 2025, 15(1): 39822. doi:10.1038/s41598-025-23408-x.
[45]	冯梓嘉, 朱建树, 付长峰. 术前诊断困难的脊柱感染性疾病2例报道[J]. 中华骨与关节外科杂志, 2025, 18(12): 1149-1152. doi:10.3969/j.issn.2095-9958.2025.12.14.
[46]	Galloway K M, Parker R. Could an increase in vigilance for spinal tuberculosis at primary health care level, enable earlier diagnosis at district level in a tuberculosis endemic country?[J]. Afr J Prim Health Care Fam Med, 2018, 10(1): e1-e9. doi:10.4102/phcfm.v10i1.1666.
[47]	杜润泽, 木拉德·买尔旦, 艾尔帕提·玉苏甫, 等. 基于lasso-logistic回归的脊柱结核预测模型的构建与验证[J]. 中华骨科杂志, 2026, 46(1): 49-57. doi:10.3760/cma.j.cn121113-20250306-00230.
[48]	Huang C, Zhuo J, Liu C, et al. Development and validation of a diagnostic model to differentiate spinal tuberculosis from pyogenic spondylitis by combining multiple machine learning algorithms[J]. Biomol Biomed, 2024, 24(2): 401-410. doi:10.17305/bb.2023.9663.
[49]	Bateman C. Little-used medical technology could help thousands see, hear and feel better[J]. S Afr Med J, 2015, 105(5): 334-336. doi:10.7196/samj.9682.
[50]	张伟华, 黄弦. 2005-2024年珠海市结核病患者就诊延迟趋势及影响因素分析[J]. 现代预防医学, 2025, 52(16): 3029-3034. doi:10.20043/j.cnki.MPM.202504168.
[51]	Al-Mahmood M R. A case report of a young woman with spinal tuberculosis: Pharmacological managements and rehabilitation approach (CARE-compliant)[J]. Med Case Rep Study Protoc, 2022, 3(9): e0261. doi:10.1097/MD9.0000000000000261.