Comparison of tuberculous and pyogenic spondylitis. An analysis of 122 cases.

One hundred twenty-two patients with tuberculous or pyogenic spondylitis were investigated retrospectively. Patient histories, laboratory tests, and radiographic findings were compared statistically between the two groups. Significant differences were calculated for the interval between onset of symptoms and diagnosis, erythrocyte sedimentation rate, mean vertebral loss at discharge, and sclerosis of the vertebral bodies involved. Open or closed biopsy was performed in 91 patients. The result provided a clear distinction between tuberculous and pyogenic spondylitis in 62.2%, either by means of histology or by culture growth. In pyogenic spondylitis, staphylococci were the most predominant bacteria isolated. Neurologic deficits were demonstrated in 17.8% of patients with tuberculous spondylitis and 22.7% with pyogenic spondylitis. At follow-up examinations, only two patients still had a motor deficit. Additionally, pain, gibbus formation, and bony fusion were evaluated, but no significant differences were found. The combination of several unspecific findings such as patient history, erythrocyte sedimentation rate, and radiographic assessment can lead to the correct diagnosis. A definitive diagnosis is established by means of biopsy, histologic evidence, and bacterial culture.