Are we diagnosing tb spine correctly? - The way forward

Almost half a million people fell ill with multidrug-resistant tuberculosis (MDR-TB) in this world,in 2012, yet less than one in 4 of these people was diagnosed, mainly due to a lack of access to quality diagnostic services.The results of treatment of tuberculosis are satisfactory if started early in the disease process.Early diagnosis is thus very important.Late start of treatment due to late diagnosis is a problem threatening the world today.The conventional teaching is to diagnose TB spine if the triad of constitutional symptoms ,raised ESR and spondylodiskitis on imaging is present.But other morbid conditions may mimic these features. A study of such non responders of TB Spine to standard ATT was done by further investigation to come the actual diagnosis.It was found that out of 21 such cases 15 were of anaplastic conditions, 3 of multidrug resistant tuberculosis and 3 of other miscellaneous causes. In such a scenario it becomes more so important to go for a biopsy and/or gene testing wherever feasible for the early correct diagnosis and thus the timely start of correct treatment.A review of the available literature on this subject was also done.