Sometimes the differential diagnosis between specific and non-specific spondylitis/spondylodiscitis is difficult when using only clinical and imaging signs. What is your personal experience and practical approach ?
Dear Panayot
Yes it is possible.
The prognosis for spinal tuberculosis is improved by early diagnosis and rapid intervention. A high degree of clinical suspicion is required if patients present with chronic back pain, even in the absence of neurological symptoms and signs. Medical treatment is generally effective In patients with spinal tuberculosis, antituberculous treatment should be started as early as possible.
Antituberculous treatment often needs to be instituted empirically, much before an etiological diagnosis is established. In resource-poor countries, etiological diagnoses may not be established at all.
Dear Nelson,
Therapy ex juvantibus is classic. In any case we should attempt to establish the etiological diagnosis. The problem remains with cases of non-specific spondylitis/spondylodiscitis for which an antibiogramme-dependent therapy is needed.
exclude brucellosis and Investigate with CXR and CBC and ESR (whenever possible biopsy), donn't forget that pyogenic infections like pseudomonas can also have an indolent course of illness too. At last there is no test that can rule out Tuberculosis and if still you have doubt then start standard WHO antiTB therapy for pott's disease.
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