title: Diagnosis and treatment of tuberclous spondylitis and pyogenic spondylitis in atypical cases.
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  This is a study of the diagnosis and treatment of tuberculous spondylitis and pyogenic spondylitis in atypical cases.
  
  
  BACKGROUND
  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.
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Chungnam National University, Daejeon, Korea.
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Ahn
authors.forename: June Kyu
authors.initials: JK
authors.lastname: Lee
references.citation: Clin Orthop Relat Res. 1993 Nov;(296):192-9
references.pmid: 8222424
references.citation: Radiol Clin North Am. 1991 Jul;29(4):809-27
references.pmid: 2063006
references.citation: Neurosurgery. 1993 Nov;33(5):838-44
references.pmid: 8264880
references.citation: J Spinal Disord. 1994 Jun;7(3):185-205
references.pmid: 7919642
references.citation: Spine (Phila Pa 1976). 1998 Sep 1;23(17):1885-90
references.pmid: 9762746
references.citation: Clin Infect Dis. 1997 Aug;25(2):221-4
references.pmid: 9332515
references.citation: Spine (Phila Pa 1976). 1997 Apr 1;22(7):780-5
references.pmid: 9106320
references.citation: Spine (Phila Pa 1976). 1998 Jan 1;23(1):139-43
references.pmid: 9460164
references.citation: Radiol Clin North Am. 1995 Jul;33(4):805-20
references.pmid: 7610246
references.citation: Spine (Phila Pa 1976). 1995 Nov 1;20(21):2287-92
references.pmid: 8553115
references.citation: Acta Radiol. 1993 Nov;34(6):554-8
references.pmid: 8240887
references.citation: Magn Reson Imaging Clin N Am. 1999 Aug;7(3):525-38
references.pmid: 10494533