A Comparative Study of Pyogenic and Tuberculous Spondylodiscitis

Abstract

Previous invasive spinal procedures, preceding bacteremia, fever, higher white blood cell counts, C-reactive protein, ALP, and higher fraction of neutrophils are suggestive of PS. Concurrent active tuberculosis, more indolent course and involvement of thoracic spines are suggestive of TS. When the causative organism is not identified despite all efforts at diagnosis, combination of the clinical, radiologic, and laboratory characteristics of the patient is helpful.

Spinal infections in children: a review

“…ESR also increases slightly, generally to around 40-85 mm/h (reference values between 0-20 mm/h) [4,17]. CRP, despite being low in specificity, has higher clinical value compared with ESR, when the evolution of the treatment is monitored: an increased or decreased variation in its values is related to worsening or improvement of the clinical symptoms, respectively [23].…”

“…CT-guided needle biopsy or fluoroscopy can be performed, with accuracy of up to 80% in the identification of the infection pathogen. Traditional open biopsies have 93.3% sensitivity in some case series, but with increased local morbidity [4,14,23]. Therefore, the possibility of using this diagnostic method in children who fail to respond to treatment with antibiotics is argued.…”

“…Progression to weakness and paralysis suggests the formation of an epidural abscess or kyphotic collapse in the affected part of the spine [14,22]. Predisposing factors include age (average age three years) [21], presence of comorbidities such as diabetes mellitus, cardiovascular disease, obesity, renal failure, chronic hepatitis, rheumatic disease, chronic use of steroids, cancer and AIDS [4,19,23]. The presence of previous genitourinary tract, respiratory tract or gastrointestinal infection is also observed [6,22].…”

“…In patients who have already begun taking antibiotics, the rate of identification of the pathogen decreases to around 15%. In these cases, the antibiotic therapy should be suspended for 72 hours before collecting new blood cultures [17,23,24].…”

Establishing the diagnosis of tuberculous vertebral osteomyelitis

“…Although certain clinical data may suggest TVO, unfortunately none of them is specific enough to establish the diagnosis [8,30]. In addition, the radiological findings of spinal tuberculosis are often atypical, and descriptions exist of osteolysis of just one vertebral body with no disc involvement, involvement limited to the posterior elements, and multifocal extensive spinal tuberculosis [31][32][33][34].…”