Volume 16 | Issue 1 | January-March 2021 | Page 3-9 | Harshit Dave, Dhiraj Sonawane, Vipul Shet, Ajay Chandanwale, Eknath Pawar, Saffudin Nadvi, Punite Tayde
Authers: Harshit Dave , Dhiraj Sonawane , Vipul Shet , Ajay Chandanwale , Eknath Pawar , Saffudin Nadvi , Punite Tayde 
 Department of Orthopaedics, Grant Medical College And Sir J.J. Group Of Hospitals, Byculla, Mumbai, Maharashtra, India.
 Apollo Spectra hospital Mumbai, Maharashtra, India.
 Bachelor of physiotherapy, MGM school of physiotherapy
Address of Correspondence
Dr. Dhiraj Sonawane,
Department of Orthopaedics, Grant Medical College And Sir J.J. Group Of Hospitals, Byculla,Mumbai, Maharashtra, India.
Vertebral tuberculosis is the most common form of skeletal tuberculosis, constituting approximately 50% of all cases. As a disease per se tuberculosis is a great masquerader, and spinal tuberculosis is no exception to this rule. It is a destructive disease, and clinical manifestations, laboratory findings, and imaging abnormalities may not be distinct and specific enough to make its diagnosis and to distinguish it from its close mimics like pyogenic spondylitis, brucella spondylitis, spinal metastasis, spinal lymphoma, multiple myeloma, ependymoma, plasmycytoma, inflammatory and degenerative spine. Consequently, it may be misdiagnosed and hence can increase morbidity and mortality due to several complications. Over-diagnosing tuberculosis can erroneously subject the patient to unnecessary drugs, which have their own adverse effects. The purpose of this review article is to provide a comprehensive note of close mimicks of tuberculosis and to highlight key clinicaal, radiological and microbiological features to differentiate spinal tuberculosis from its mimicks. We hope that this article help to prevent incorrect diagnosis and mismanagement leading out of it.
Keywords: Potts spine; Spinal tuberculosis; clinical features; radiological features; differential diagnosis; mimicker.
1. Tuli SM (2007) Tuberculosis of the spine: a historical review. ClinOrthop Relat Res 460:29–38
2. Polley P, Dunn R (2009) Noncontiguous spinal tuberculosis: incidence and management. Eur Spine J 18:1096–1101
3. Tuli SM (2002) General principles of osteoarticular tuberculosis. Clin Orthop Relat Res 11–19
4. Garg RK, Somvanshi DS. Spinal tuberculosis: A review. J Spinal Cord Med 2011;34:440-54.
5. Jain AK (2007) Tuberculosis of the spine. Clin Orthop Relat Res 460:2–3
6. Schirmer P, Renault CA, Holodniy M. Is spinal tuberculosis contagious? Int J Infect Dis 2010;14(8):e659–66.
7. Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 2010;92(7):905–13.
8 Jain AK, Dhammi IK. Tuberculosis of the spine: a review. Clin Orthop Relat Res 2007;460(July) 39–49.
9. Gautam MP, Karki P, Rijal S, Singh R. Pott’s spine and Pott’s paraplegia. J Nep Med Assoc 2005;44(159):106–15.
10. Kotil K, Alan MS, Bilge T. Medical management of Pott disease in the thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine 2007;6(3):222–8
11.Tuli SM. Tuberculosis of the shoulder. Tuberculosis of the skeletal system. 1st ed New Delhi: JayPee Brothers Medical Publisher (P) Ltd; 1993
12. McLain RF, Isada C. Spinal tuberculosis deserves a place on the radar screen. Cleve Clin J Med 2004;71(7):543–9 [PubMed] [Google Scholar]
13. Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 2010;92(7):905–13 [PubMed] [Google Scholar]
14. Lee KY. Comparison of pyogenic spondylitis and tuberculous spondylitis. Asian Spine J 2014;8:216-23
15. Esteves S, Catarino I, Lopes D, Sousa C. Spinal tuberculosis: Rethinking an old disease. J Spine 2017;6:358
16. Jung NY, Jee WH, Ha KY, Park CK, Byun JY. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR 2004;182:1405-10.
17. Kumaran SP, Thippeswamy PB, Reddy BN, Neelakantan S, Viswamitra S. An Institutional Review of Tuberculosis Spine Mimics on MR Imaging: Cases of Mistaken Identity. Neurol India 2019;67:1408-18
18. S.B. Strauss, S.R. Gordon, J. Burns, J.A. Bello and S.E. SlaskyAmerican Journal of Neuroradiology December 2019, DOI: https://doi.org/10.3174/ajnr.A6370
19. Li T, Liu T, Jiang Z, Cui X, Sun J. Diagnosing pyogenic, brucella and tuberculous spondylitis using histopathology and MRI: A retrospective study. Exp Ther Med. 2016;12(4):2069-2077. doi:10.3892/etm.2016.3602.
20. Patnaik S, Jyotsnarani Y, Uppin SG, Susarla R. Imaging features of primary tumors of the spine: A pictorial essay. Indian J Radiol Imaging 2016;26:279-89
21. Clayton F, Butlers JJ and Ayala AG : Non-Hodgkin’s lymphoma in bone: pathological and radiological features with clinical correlates. Cancer 1987; 60:2494
22.Huang B, Li CQ, Liu T, Zhou Y. Primary non-Hodgkin’s lymphoma of the lumbar vertebrae mimicking tuberculous spondylitis: A case report. Arch Orthop Trauma Surg 2009;129:1621-5.
Maheshwari, Veena, et al. “Lymphoma of spine presenting as Pott’s desease: A case report.” Ind J Tub 47 (2000): 107-8
23. Shankar J, Jayakumar P, Vasudev M, Ravishankar S, Sinha N. The usefulness of CT perfusion in differentiation between neoplastic and tuberculous disease of the spine. J Neuroimaging 2009;19:132-8
24. Yeom JA, Lee IS, Suh HB, Song YS, Song JW. Magnetic resonance imaging findings of early spondylodiscitis: Interpretive challenges and atypical findings. Korean J Radiol 2016;17:565-80.
25. Lang N, Su MY, Hon JY, Yuan H. Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI. European Spine Journal. 2015 Aug 1;24(8):1729-37.
26. Muradali D, Gold WL, Vellend H, Becker E. Multifocal osteoarticular tuberculosis: Report of four cases and review of management. Clin Infect Dis 1993;17:204-9.
27. Chowdhary, Gurjeet Singh, Abhishek Purkayastha, and Ritu Mehta. “Multifocal skeletal tuberculosis mimicking multiple myeloma and secondary bone metastasis: An unusual case scenario.” Archives of Medicine and Health Sciences 6.1 (2018): 126.
27. Laredo JD, el Quessar A, Bossard P, Vuillemin- Bodaghi V. Vertebral tumors and pseudotumors. Radiol Clin North Am 2001;39(1):137–163, vi.
28. Shah BK, Saifuddin A, Price GJ. Magnetic reso- nance imaging of spinal plasmacytoma. Clin Radiol 2000;55(6):439–445
29. Baba H, Maezawa Y, Furusawa N, Wada M, Kokubo Y, Imura S, Imamura Y, Yamada Y. Solitary plasmacytoma of the spine associated with neurological complications. Spinal Cord. 1998 Jul;36(7):470-5.
30. Bron JL, de Vries MK, Snieders MN, van der Horst-Bruinsma IE, van Royen BJ. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol 2009;28:883-92
31. Langlois S, Cedoz JP, Lohse A, Toussirot E, Wendling D (2005) Aseptic discitis in patients with ankylosing spondylitis: a retrospective study of 14 cases. Jt Bone Spine 72(3):248–253
32. Bron JL, de Vries MK, Snieders MN, van der Horst-Bruinsma IE, van Royen BJ. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol. 2009;28(8):883-892. doi:10.1007/s10067-009-1151-x
33. Del Grande M, Del Grande F, Carrino J, Bingham CO 3rd, Louie GH. Cervical spine involvement early in the course of rheumatoid arthritis. Semin Arthritis Rheum 2014;43:738-44
34. Vital JM, Gille O, Pointillart V, Pedram M, Bacon P, Razanabola F, et al. Course of Modic 1 six months after lumbar posterior osteosynthesis. Spine 2003;28:715-21.
|How to Cite this article: Dave H, Sonawane D, Shet V, Chandanwale A, Pawar E, Nadvi S, Tayde P. Spinal Tuberculosis a Great Mimicker.. Journal of Trauma and Orthopaedic Surgery January-March 2021;16(1): 3-9.|