{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:53:56Z","timestamp":1791251636489,"version":"4.1.0"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Population-based ecological study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify the national inpatient burden, treatment patterns, and in-hospital mortality of spinal tuberculosis (STB) in Germany, and to test whether demographic change is associated with STB hospitalisation rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The German InEK DRG browser was analysed for inpatient STB episodes (ICD-10-GM A18.0 as principal diagnosis with a secondary diagnosis from category M49.0-; n = 671; case years 2019\u20132025), integrated with national TB hospitalisation data (2015\u20132024), population statistics by nationality, and migration data. Joinpoint regression, Poisson and negative binomial (NB) modelling with population offset, age-standardized rates (ESP2013), and Kitagawa decomposition were applied, with sensitivity analyses including lagged migration denominators and COVID-period exclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>STB hospitalisation rates remained stable (ASR 0.11\u20130.14\/100,000; annual percent change \u22123.1%, P = .14), while total TB declined 29% (joinpoint 2022, P = .022). Patients were predominantly male (70.3%) and aged 18\u201339 years (56%\u201369%). In-hospital case fatality was below 0.5%. Surgical DRG assignment varied from 13.5% to 42.2%. The temporal trend was flat (IRR 0.97 per year, 95% CI 0.92\u20131.02). Despite a 43% increase in the foreign-national population (P &lt; .001), no increase in STB episodes was detectable, whether the population was modelled alongside calendar year (IRR 1.03 per million, 95% CI 0.55\u20131.92) or without it (IRR 0.93, 95% CI 0.84\u20131.04). Kitagawa decomposition (2019\u21922024) attributed the rate component to \u221210.5 episodes versus +0.5 from population growth. All sensitivity analyses confirmed these null findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The national inpatient STB burden is low but stable and decoupled from overall TB hospitalisation trends. No increase in STB hospitalisations was detectable during the observed demographic change, although individual-level associations with migration could not be assessed. Very low in-hospital mortality contrasts with pyogenic spondylodiscitis. Marked variation in surgical DRG assignment warrants standardized care pathways at specialized centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261491253","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:28:11Z","timestamp":1790857691000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["National Inpatient Burden, Treatment Patterns, and In-Hospital Mortality of Spinal Tuberculosis in Germany Amid Demographic Change: A Population-Based DRG Study, 2019\u20132025"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0459-9092","authenticated-orcid":false,"given":"Siegmund","family":"Lang","sequence":"first","affiliation":[{"name":"University Hospital Regensburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josina","family":"Straub","sequence":"additional","affiliation":[{"name":"University Hospital Regensburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3057-2600","authenticated-orcid":false,"given":"Jonas","family":"Kr\u00fcckel","sequence":"additional","affiliation":[{"name":"University Hospital Regensburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7224-4272","authenticated-orcid":false,"given":"Marcin T.","family":"Czyz","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8943-5817","authenticated-orcid":false,"given":"Julian","family":"Scherer","sequence":"additional","affiliation":[{"name":"University Hospital Zurich"},{"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_3_7_2_2","volume-title":"Global Tuberculosis Report 2025","author":"World Health Organization","year":"2025","unstructured":"World Health Organization. Global Tuberculosis Report 2025. World Health Organization; 2025."},{"key":"e_1_3_7_3_2","volume-title":"Tuberculosis Surveillance and Monitoring in Europe 2026\u20142024 Data","author":"European Centre for Disease Prevention and Control, WHO Regional Office for Europe","year":"2026","unstructured":"European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis Surveillance and Monitoring in Europe 2026\u20142024 Data. 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Evaluation of clinical, laboratory, radiographical and histopathological characteristics in patients with spinal tuberculosis in the context of HIV infection. S Afr Med J. 2024;114(11):e2065.","journal-title":"S Afr Med J"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s43390-023-00785-9"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2015.07.013"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00214014"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2017.22.12.30491"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"issue":"272","key":"e_1_3_7_23_2","first-page":"1168","article-title":"Components of a difference between two rates","volume":"50","author":"Kitagawa EM","year":"1955","unstructured":"Kitagawa EM. 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