ArticleFrontiers in surgery2026
Development and validation of a nomogram for predicting postoperative bone nonunion in spinal tuberculosis patients.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Postoperative bone nonunion is a critical complication following instrumented fusion for spinal tuberculosis. Preoperative prediction is essential for prevention. While clinical risk factors exist, current predictive tools lack validation in infected cohorts. Purpose: This study developed and validated a multivariate nomogram, provided an individualized preoperative estimate of nonunion risk in spinal tuberculosis patients, incorporating key clinical and radiological predictors to guide preventative strategies. Method: A retrospective cohort of 178 patients undergoing debridement and instrumented fusion for spinal tuberculosis (Shandong Public Health Clinical Center, January 2021-January 2024) was stratified by Bridwell classification into union ( Results: The training cohort of this study comprised 178 patients, of which 120 presented with union and 58 with nonunion. Five predictor variables were screened by LASSO regression and plotted as a nomogram, including ALB, CRP normalization days, Bone graft materials, Psoas abscess, Jumping lesions. The nomogram showed strong discrimination and solid calibration, AUC = 0.947 (95% confidence 0.915-0.978). The calibration curves of the diagnostic models showed the optimal concordance between the predicted results and the actual observations. The DCA indicated that the substantial clinical net benefit across threshold probabilities. Conclusion: The study successfully developed a precise and effective nomogram for identifying postoperative bone nonunion in spinal tuberculosis patients. This nomogram aids early detection and prevention in postoperative bone nonunion, improving clinical decisions and treatment optimization.
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