Abstract Objective To explore the clinical manifestations, diagnostic pitfalls, and management strategies of spinal infection misdiagnosed as osteoporotic vertebral compression fracture (OVCF) and treated with percutaneous vertebroplasty (PVP), summarize lessons learned, improve treatment procedures, and prevent similar serious medical errors from recurring. Methods A retrospective analysis was conducted on a case in our hospital where a patient presented with low back pain, and imaging suggested a vertebral compression fracture, which was misdiagnosed as OVCF and treated with PVP. Clinical data, laboratory tests, imaging findings, postoperative course, and management of complications were collected. Based on a literature review, in-depth discussions were held regarding clinical diagnosis, imaging differentiation, preoperative examination, pathological confirmation, and multidisciplinary team (MDT) collaboration, and standardized treatment recommendations were proposed. Results The patient did not undergo preoperative testing for inflammatory markers such as ESR and CRP, nor did they undergo contrast-enhanced MRI. During PVP, after injecting bone cement into the potential infection site, the patient developed persistent high fever and rapid spread of infection. Postoperatively, the condition was controlled after multiple lesion removals, bone cement removal, and long-term antibiotic treatment. However, the treatment process was complex, extremely risky, and resulted in slow recovery and high consumption of medical resources. Analysis suggests that the main reasons for misdiagnosis include: ① Insufficient clinical history taking and physical examination, resulting in failure to identify infection clues; ② Inadequate preoperative imaging assessment, lacking enhanced MRI and pathological confirmation; ③ Missing preoperative safety check procedures, failing to rule out absolute contraindications for PVP. Conclusion: Spinal infections and OVCF share certain similarities in clinical manifestations and early imaging features, easily leading to misdiagnosis and mistreatment.
目的
探讨脊柱感染误诊为骨质疏松性椎体压缩性骨折（OVCF）并行经皮椎体成形术（PVP）的临床表现、诊断误区及处理策略，总结经验教训，完善诊疗流程，避免类似严重医疗差错再次发生。
方法
回顾分析我院1例因腰背痛就诊、影像学提示椎体压缩性骨折而误诊为OVCF并行PVP的病例。收集患者临床资料、实验室检查、影像学表现、术后病程及并发症处理经过，并结合文献复习，从临床诊断、影像学鉴别、术前检查、病理学确诊及多学科协作（MDT）等方面进行深入讨论，提出规范化诊疗建议。
结果
患者术前未行ESR、CRP等炎症指标检测及MRI增强扫描，PVP术中将骨水泥注入潜在感染灶后，出现持续高热及感染迅速扩散。术后经多次病灶清除、骨水泥取出及长期抗菌治疗后病情控制，但治疗过程复杂、风险极高，恢复缓慢，医疗资源消耗大。分析认为，误诊的主要原因包括：① 临床问诊查体不足，感染线索未被识别；② 术前影像学评估不完善，缺乏增强MRI和病理学确诊；③ 术前安全核查流程缺失，未能排除PVP绝对禁忌症。
结论
脊柱感染与OVCF在临床表现和影像学早期特征上有一定相似性，易导致误诊误治。PVP/PKP术前应严格排查感染、肿瘤等禁忌症，常规行血常规、ESR、CRP检查，必要时行MRI增强及穿刺活检确诊。应建立和落实“PVP术前安全核查表”，加强临床-放射科-感染科-病理科的MDT沟通，强化“诊断先于治疗”理念，以保障医疗安全，减少灾难性并发症的发生。