title: Tuberculous spondylitis in elderly Japanese patients.
abstract: BACKGROUND
  Although the number of patients with tuberculous spondylitis in Japan is increasing slowly, the proportion of the elderly among these patients is increasing more quickly. The purpose of this study was to describe the clinical features and diagnostic imaging findings in elderly tuberculous spondylitis patients in order to enhance diagnosis of the condition in the elderly population.
  
  
  METHODS
  We conducted a retrospective review of 23 patients over 70 years of age previously diagnosed with tuberculous spondylitis. Clinical signs and symptoms, including local pain, fever, and neurological deficits, were analyzed. Routine laboratory tests, including the erythrocyte sedimentation rate, the white blood cell count, and the C-reactive protein level were also reviewed. The results of plain X-rays and magnetic resonance imaging were studied.
  
  
  RESULTS
  Patients' signs and symptoms were as follows: local pain in 19 patients (83%); fever in 7 patients (30%) and no fever in 16 patients (70%); and neurological deficits in 13 patients (57%). C-Reactive protein was less than 1.0 mg/dl in 6 patients (26%). Radiography revealed several changes in the affected vertebrae; 3 patients had atypical changes involving only a single vertebra.
  
  
  CONCLUSIONS
  It is difficult to diagnose tuberculous spondylitis in the elderly because there are atypical symptoms, a scarcity of inflammatory changes, and degenerative changes normally seen in the elderly may mask the radiographic changes due to tuberculous spondylitis. Tuberculous spondylitis should be considered a possibility in the differential diagnosis of back pain in the elderly, especially in countries with a significant history of tuberculosis in the population.
authors.affiliation: Department of Orthopaedic Surgery, Osaka Minami Medical Center, Kawachinagano, Osaka, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Maeda
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Izawa
authors.forename: Takaharu
authors.initials: T
authors.lastname: Nabeshima
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yonenobu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D019637:Orthopedic Procedures; D010014:Osteolysis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D013166:Spondylitis / Q000175:diagnosis* / Q000382:microbiology*; D014399:Tuberculosis, Spinal / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000995:Antitubercular Agents