An analysis of clinicoradiological and histopathological correlation in tuberculosis of spine

Two hundred and sixty-seven consecutive patients with clinical and radiological features suggestive of tuberculosis of the spine treated over a period of five years were analysed : (1) To assess how dependable clinical and radiological features are in establishing a diagnosis of spinal tuberculosis and (2) to identify other conditions which may have clinical and radiological features similar to those seen in patients with spinal tuberculosis. This retrospective case series analysis was done in a university teaching hospital in south India. The clinical presentation, radiological features and the erythrocyte sedimentation rate were correlated with the histopathological diagnosis on tissue obtained by open biopsy in 130 cases during surgery and in 137 cases by closed vertebral biopsy. One hundred sixty-six cases were histologically proved as tuberculosis and 74 proved to be non-tuberculous lesions. Twenty-seven cases in which the biopsy was inconclusive were excluded from the study. The study demonstrated that tuberculous lesions were commoner in younger patients and the lesion was more often in the paradiscal region as compared to non-tuberculous lesions. However, all other clinical and radiological variables were not significantly different to enable reliable identification of tuberculous lesions on the basis of clinical and radiological features alone. It is recommended that all vertebral lesions suspected to be of tuberculous origin not responding to empirical antituberculosis therapy should have a definitive histopathological diagnosis to facilitate appropriate treatment.