Mycobacteroides abscessus complex vertebral osteomyelitis and discitis of the thoracolumbar spine: a systematic review of management and outcomes with illustrative case.

INTRODUCTION: Mycobacteroides abscessus complex (MAbC) is a rapidly growing non-tuberculous mycobacterium that can cause vertebral osteomyelitis in rare cases. This study systematically reviews the literature on MAbC vertebral osteomyelitis and presents a representative case. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided review of PubMed/MEDLINE, Scopus, and Web of Science (from inception to December 2025) identified studies reporting MAbC vertebral osteomyelitis. Eligible cases included data on presentation, diagnosis, treatment, and outcomes. Risk of bias was assessed using Joanna Briggs Institute tools. RESULTS: Twenty-three studies (28 patients) were included. The mean age was 56.2 years; 42.9% were male. Most patients presented with back pain, and 75.0% were immunocompetent. Antibiotic therapy was universal, and 70.0% underwent surgery. Younger age, female sex, granulomatous pathology, and surgical intervention were associated with improved outcomes (p < 0.05). CONCLUSION: MAbC vertebral osteomyelitis is rare and diagnostically challenging. Early tissue diagnosis and combined medical-surgical management are associated with improved outcomes, highlighting the importance of timely recognition and individualized treatment strategies. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261333174, identifier CRD420261333174.