Comparison of Pyogenic and Tuberculous Spondylitis

Study Design : Infectious spondylitis patients were classified according to their cause in pyogenic and tuberculous and compared by each. Summary of Literature Review : Tuberculous spondylitis shows chronic clinical course and disc space sparing with much pus formation in radiologic finding compared to pyogenic spondylits. Purpose : To compare pyogenic and tuberculous spondylitis in clinical, radiological, pathological difference for appropriate management of infectious spondylitis. Materials and Methods : We reviewed sixty two cases of infectious spondylitis confirmed by culture and pathologic findings of specimens which obtained by surgical method at the orthopaedic department of the Dong-A university hospital between June 1990 and November 1998. Results : There were 18 cases of pyogenic and 44 cases of tuberculous spondylitis, and combined infection case was absent. Average period between beginning of symptom and diagnosis was 6.4 months in pyogenic spondylitis(4-11 months), 3.9 months in tuberculous spondylitis(3-39 months). The average number of affected vertebra was 2.3 in pyogenic spondylitis and 3.9 in tuberculous spondylitis. 6 cases of pyogenic spondylitis(33%) showed high fever(above 38°C) which not presented in tuberculous spondylitis. We could not find considerable difference in leukocyte count, ESR, CRP level and simple radiologic finding, MRI finding between pyogenic and tuberculous spondylitis. Conclusions : In our study, most pyogenic spondylitis shows chronic and inactive feature, so clinical, radiological, laboratory findings are not appropriate guide to differentiate between pyogenic and tuberculous spondylitis. Culture growth of infecting agent and histologic examination are reliable and essential diagnostic method for pyogenic and tuberculous spondylitis.