Diagnosis and Treatment of Tuberclous Spondylitis and Pyogenic Spondylitis in Atypical Cases

STUDY DESIGN: A retrospective study. PURPOSE: This is a study of the diagnosis and treatment of tuberculous spondylitis and pyogenic spondylitis in atypical cases. OVERVIEW OF LITERATURE: There have been several reports about clinical, hematological, pathological and radiological findings to differentiate pyogenic & tuberculous spondylitis. METHODS: We screened 55 patients diagnosed with tuberculous spondylitis and pyogenic spondylitis from January 1999 to June 2003. There were seven cases where it was difficult to make an accurate diagnosis. We reviewed the clinical manifestation, laboratory tests, radiological findings and confirmed the diagnoses by the use of biopsies and/or clinical response to treatment. RESULTS: Four cases, which were initially diagnosed as pyogenic spondylitis, had a clinical presentation of fever (37.4~38.5℃) on the day of hospitalization. These cases later turned out to be tuberculous spondylitis, as confirmed by an open biopsy and pathologic study. Three cases initially diagnosed as pyogenic spondylitis were treated with broad-spectrum antibiotics. Symptoms were aggravated in these cases, but improved after the use of an anti-tubercular drug. Bony union was observed in all cases in an averageof 4 months (range, 3~6 months). CONCLUSIONS: In infectious spondylitis, it is important to establish an accurate diagnosis. An accurate diagnosis can be made by laboratory findings and by estimation of the response to treatment during follow-up. If there is no response or aggravation of symptoms despite treatment based on an initial diagnosis, the etiologic organism must be re-evaluated. A biopsy and observation of clinical response are needed to confirm the diagnosis.