Tuberculous spondylitis--analysis of 22 cases

Tuberculous spondylitis (TS) frequently poses both diagnostic and therapeutic challenges. The clinical symptoms, radiological imaging studies and laboratory tests are quite often inconclusive in the early stages of the disease.

To identify early clinical symptoms, review results from radiological imaging studies and laboratory tests to establish their diagnostic value and determine the effect of conservative therapy in patients with early TS.

Twenty two (22) patients with TS subjected to conservative therapy were studied. Medullary compression syndrome was found in 10 patients. The highest diagnostic value was established by Magnetic Resonance Imaging (MRI) data for discitis engaging two adjacent vertebrae and QuantiFERON TB Gold and T SPOT.TB tests. The effect of the disease on 12 patients, whose treatment had started before the collapse of the bodies of the vertebrae was non-occurrence of any residual deformity of the spinal column. The effect on 9 patients, whose therapy started at a later stage was a recovery of the neurological deficiency and deformity occurrence of various degrees.

Repetitive lateral plain radiographs, MRI and QuantiFERON TB Gold test have proven of highest diagnostic value at this stage of the disease in our patients. The presence of clinical data, accelerated ESR levels, plain radiography and MRI evidence of an inflammatory process preceding the occurrence of bone destruction and the formation of paravertebral soft tissue collection provide sufficient reasons to conduct QuantiFERON TB Gold or T SPOT.TB testing and start an antituberculous therapy. In the frequent cases when the diagnosis cannot be sufficiently proven, we recommend empirical anti-tuberculous therapy.