Spinal tuberculosis in developed countries: difficulties in diagnosis.

A review of 21 cases of patients with spinal tuberculosis has been performed, with special attention being paid to methods of diagnosis and the surgical treatment undertaken. We found that the clinical presentation of the condition was often similar to that of malignant disease within the spine, with the commonest presenting features being back pain (95%), an evaluated erythrocyte sedimentation rate (ESR) (100%) and neurological deficits (47%). The radiological appearances were diagnostic of spinal tuberculosis in less than 50% of cases. Microbiological confirmation of the diagnosis was possible only by direct analysis of tissue or pus, either at operation or from a vertebral biopsy. The difficulty of diagnosing this condition and the implications that this has on the timing and nature of surgery in patients presenting with neurological deficits are discussed.