Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2009 Jun;16(2):112-121. Korean.
    Published online Jun 30, 2009.
    https://doi.org/10.4184/jkss.2009.16.2.112
    Copyright © 2009 Korean Society of Spine Surgery
    Original Article

    Differential Diagnosis between Tuberculous Spondylitis and Pyogenic Spondylitis

    Ki-Hyoung Koo, M.D.,# Hyeok-Jin Lee, M.D., Bong-Soon Chang, M.D., Jin-Sup Yeom, M.D., Kun-Woo Park and Choon-Ki Lee, M.D.
      • Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Korea.
      • #Department of Orthopaedic Surgery, Dongguk University International Hospital, Goyang, Korea.
    • Address reprint requests to: Bong-Soon Chang, M.D. Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea. Tel: 82-2-2072-3864, Fax: 82-2-764-2718, Email: bschang@snu.ac.kr

    Abstract

    Study Design

    This is a retrospective study.

    Objectives

    We wanted to make the early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis according to the clinical and MRI findings.

    Summary of the Literature Review

    Making an early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis is essential to start prompt and proper treatment. However, the clinical symptoms and MRI findings of both these illnesses can vary considerably.

    Material and Method

    Ninety-five patients (49 men and 46 women, mean age: 54.5) who were treated from January 2001 to February 2007 and whose diagnosis was confirmed by laboratory or pathological studies were retrospectively reviewed. 50 patients with tuberculous spondylitis and 45 patients with primary pyogenic spondylitis were included. The patients with combined infection or an uncertain diagnosis were excluded. We compared the medical records and MRI findings between the different groups of patients.

    Results

    The patients with tuberculous spondylitis were younger (48.2 years vs. 61.5 years, respectively) and they had a longer symptom duration (4.3 months vs 1.8 months, respectively). The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level were significantly higher in the patients with pyogenic spondylitis (71.3/49.6 mm/hr and5.74/2.98 mg/dl, respectively). A high fever above 38 degree was more frequent in the patients with pyogenic spondylitis. Intraosseous abscess, epidural abscess, a well-definded paraspinal abscess, focal enhancement and severe destruction of the vertebral body on MRI were more frequent in the patients with tuberculous spondylitis. Four parameters such as a symptom duration longer than 3 months, no fever higher than 38 degree, a well-defined paravertebral abscess and an intraosseous abscess were selected. 42 patients in the tuberculous group had 3 or more of these four parameters. The sensitivity and specificity of these combined 4 parameters were 84% and 97.8%, respectively, for making the differential diagnosis between these 2 maladies.

    Conclusion

    These diagnostic criteria might be useful to discriminate between tuberculous spondylitis and pyogenic spondylitis even without definite laboratory or pathological results.

    Keywords
    Infectious spondylitis; Tuberculous spondylitis; Pyogenic spondylitis; Differential diagnosis; MRI

    Figures

    Fig. 1
    A 32-year-old man with tuberculous spondylitis. He had the symptom duration of 1 month. ESR was 71 mm/hr. Fever higher than 38 degree and neurologic deficit were not observed. (A). T1 weight image shows loss of cortical definition, anterior wedging less than 50% of body. T2 weight image shows inhomogenous hyperintensity and relative disc preservation. Enhanced sagittal image shows inhomogenous focal enhancement. intraosseous abscess with rim enhancement and epidural abscess. (B) Enhanced axial image shows epidural abscess, well-defined rim-enhanced paraspinal abscess and intraosseous abscess.

    Tables

    Table 1
    Clinical features of patients.

    Table 2
    Radiologic findings of patients.

    Table 3
    Intraobserver and interobserver reliablity

    Table 4
    Sensitivity and specificity of features for tuberculous spondylitis.

    Table 5
    Trends of diagnostic criteria for tuberculous spondylitis.

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    MeSH Terms
    Abscess
    Blood Sedimentation
    C-Reactive Protein
    Diagnosis, Differential
    Epidural Abscess
    Female
    Fever
    Humans
    Male
    Medical Records
    Retrospective Studies
    Sensitivity and Specificity
    Spondylitis
    Metrics
    Share
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