Tumour, Tuberculosis and Osteomyelitis of the Spine:<i>Differential Diagnostic Aspects</i>

Paus, Bernhard

doi:10.3109/17453677308989073

Cited by 19 publications

(6 citation statements)

References 6 publications

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“…During recent years the picture has changed and tuberculous spondylitis has become relatively uncommon, whereas osteomyelitis of scptic origin has increased in fre- Ambrose lit al. 1966, Paus 1973, among others). I t is ohvious that the condition presents diagnostic pitfalls and is difficult to differentiate from other diseases, especially tuberculous spondylitis.…”

mentioning

confidence: 99%

Osteomyelitis of the Spine

Collert

1977

Acta Orthopaedica Scandinavica

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confidence: 99%

Osteomyelitis of the Spine

Collert

1977

Acta Orthopaedica Scandinavica

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“…(Fornasier und Czitrom 1978). Zum anderen sind, was die Art einer Läsion betrifft, generell die entzündlichen Erkrankungen (unspezifische und spezifische Spondylitiden -einschließlich Pilzerkrankungen) von den Geschwülsten und neuropathischen Veränderungen zu trennen (Bette 1955;Taubert 1958;Risk6 et al 1960;Paus 1973;Goldman und Freiberger 1979;Brocher und Willert 1980). Dabei gibt es gewisse röntgenologische Hinweise, die eher für einen bösartigen als für einen entzündlichen Prozeß sprechen: die Auslöschung der Bogenwurzel in der a.p.…”

Section: Szintigraphische Befun Deunclassified

“…b) Notwendigkeit einer exakten Diagnose Wir sind mit Sperling (1960), Francis und Hutter (1963) und Paus (1973) der Ansicht, daß eine exakte Diagnose unbedingt notwendig ist, wenn die in den letzten Jahren eingeführten differenzierten und aufwendigen Behandlungsverfahren der Wirbelsäulenerkrankungen sinnvoll zur Anwendung kommen sollen. Keinesfalls können wir die Ansicht Becker's (1979) .…”

Section: Ungeklärte Fälleunclassified

“…Anamnese, klinische Untersuchung und Laboratoriumsdiagnostik sind dabei unerläßliche Voraussetzung, um die Röntgenuntersuchung gezielt einsetzen zu können. Vor allem sind es die herdförmigen Wirbelsäulenerkrankungen, die durch die erwähnten Unrersuchungsmethoden häufig nicht eindeutig geklärt werden können (Craig 1956;Kastert 1962;Nagel et al 1965;Mach 1968;Paus 1973). Eine exakte Diagnose ist aber notwendig, wenn die in den letzten Jahren entwickelten differenzierten Behandlungsverfahren erfolgreich zur Anwendung kommen sollen.…”

Section: Introductionunclassified

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Zur Diagnostik herdförmiger Wirbelsäulenerkrankungen - eine kritische Betrachtung*

Enderlé¹,

Schmitt²,

Zichner³

2008

Z Orthop Ihre Grenzgeb

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The article offers a critical review of the diagnosis of focal diseases of the vertebral column, based on 200 histological vertebral column examinations. The findings obtained by means of the roentgenological, histological and bacteriological examinations can be subdivided into 6 groups: 1. Non-specific and specific cases of spondylitis (59 patients); 2. Systemic malignant diseases and primarily malignant tumours (23 patients); 3. Metastases (71 patients); 4. Benign tumours (11 patients); 5. Miscellaneous cases (28 patients) and 6. Unclarified cases (8 patients). The authors comment on the following points with specific reference to the results obtained by them: a) Possibilities and limitations of roentgenological diagnosis: roentgenologically, the inflammatory diseases are most easy to identify, but is not always possible to differentiate safely between non-specific, specific and plasmacellular spondylitis. There are clear limitations to the diagnosis of the type of focal diseases of the spinal column; this applies particularly to the benign and malignant types of tumours. b) Necessity of arriving at an accurate diagnosis: it is imperative to aim at an accurate diagnosis before any meaningful therapy can be initiated. The mandatory need for this is explained via examples covered by the present study. c) Closed or open biopsy: it is shown by means of a review of the literature that open biopsy yields more representative material for the histological examination than closed needle biopsy. It goes without saying that this is a true prerequisite for an accurate histological diagnosis. In this connection, the authors go into the details of the difficulties governing any histological examination. d) informative value of further additional examinations: Scintigraphy, tomography and computer tomography may be valuable aids in the discovery and better visualisation of a vertebral focus, but they are not helpful in arriving at a diagnosis regarding the type of focus involved. Laboratory examinations are not very helpful, either. e) Accuracy of the authors' own diagnostic measures: in spite of open biopsy, 177 cases only out of 200 (88%) could be diagnosed on a purely histological basis. In 12 further cases, diagnosis was established after correlation of the histological finding with the x-ray film. 8 cases (4%) could not be clarified. In 7 patients (3.5%) it must be assumed that the focus was not located despite open biopsy.

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“…So distinguishing spinal metastasis from spinal TB is essential to reduce pain, prevent neurological disability, minimize spinal deformity, and improve prognosis [5,6]. However, spinal metastasis and spinal TB show similar clinical manifestations and imaging features such as back pain, weakness, weight loss, vertebrae destruction, patholog-ical fracture, kyphosis deformity, and even neurological dysfunction [7], so it is difficult to distinguish the two accurately, especially in the outpatient department because of the limited consultation time and examination condition [8]. Although biopsy has been proved as the gold standard to distinguish spinal metastasis from spinal TB [9], it cannot be conducted in the outpatient department, so in actual outpatient work, the diagnosis was mainly dependent on the combination of clinical findings and auxiliary examination [3,10].…”

Section: Introductionmentioning

confidence: 99%

A Scoring System for Outpatient Orthopedist to Preliminarily Distinguish Spinal Metastasis from Spinal Tuberculosis: A Retrospective Analysis of 141 Patients

She

et al. 2021

Disease Markers

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Objective. Spinal tuberculosis (TB) misdiagnosed of spinal metastasis was not rarely reported, especially in outpatients department. This study was aimed to establish an outpatient scoring system to preliminarily distinguish spinal metastasis from spinal TB. Methods. We retrospectively reviewed consecutive 141 patients with a pathological diagnosis of spinal metastasis (82 cases) or spinal TB (59 cases) in our hospital from January 2017 to June 2018. The following clinical characteristics which can be obtained by outpatient orthopedist were recorded and analyzed: age, gender, malignant tumor history, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and imaging features including distribution characteristics of vertebral lesions, subligamentous spread, paravertebral or psoas abscess, involved vertebral element, intervertebral disc, and sequestra formation. The prevalence of clinical characteristics in spinal metastasis was evaluated, and the scoring system was established using logistic regression analysis. The performance of the scoring system was also prospectively validated. Results. The outpatient scoring system was based on five clinical characteristics confirmed as significant predictors of spinal metastasis, namely, malignant tumor history, subligamentous spread, posterior element lesions, preserved discs, and no sequestra formation. Spinal metastasis showed a significant higher score than spinal TB (8.17 points vs. 1.97 points, t = 18.621 , P < 0.001 ), and the optimal cut-off value for the scoring system was 5 points. The sensitivity and specificity of the scoring system for predicting spinal metastasis were 97.85% and 88.33%, respectively, in the validation set. Conclusion. Spinal lesions with the score of 5 to 10 would be considered a diagnosis of spinal metastasis, while the score of 0 to 4 may be spinal TB. Because the scoring system is mainly based on the clinical characteristics that can be obtained by an outpatient orthopedist, it is suitable to be used as a diagnostic tool in the outpatient department.

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Tumour, Tuberculosis and Osteomyelitis of the Spine:Differential Diagnostic Aspects

Cited by 19 publications

References 6 publications

Osteomyelitis of the Spine

Osteomyelitis of the Spine

Zur Diagnostik herdförmiger Wirbelsäulenerkrankungen - eine kritische Betrachtung*

A Scoring System for Outpatient Orthopedist to Preliminarily Distinguish Spinal Metastasis from Spinal Tuberculosis: A Retrospective Analysis of 141 Patients

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