We read the article by Gupta N et al. about differential diagnosis of tubercular (TB) and pyogenic spinal involvement based on magnetic resonance imaging (MRI).1 The authors reviewed data of 90 patients with infectious spondylodiscitis confirmed by microbiological studies of biopsy or blood samples, and mycobacterial GeneXpert assay. They compared in all cases the number of affected vertebrae, paravertebral soft tissue involvement, largest abscess diameter (including the epidural), kyphosis, and scoliosis, involvement of pedicles, spinous processes and discs, and loss of vertebral height.1 Pyogenic spondylitis (n=46) was due to Brucella (n=22), Staphylococcus aureus (n=12), Enterobacteriaceae (n=9), Streptococcus spp. (n=2), or Burkholderia pseudomallei (n=1). Patients with TB had more lesions in thoracic spine; soft tissue, abscess, posterior element or disc involvement; loss of vertebral height; spine deformity; and nerve compression.1 Of note was their scoring system for diagnosis of TB spinal including 11 points, with a score of 7 points or above corresponding to 86% of sensitivity and 94% of specificity. Two points each for: thoracic spine, posterior element, and spine deformity; and one point each for: paravertebral soft tissue involvement, epidural abscess, loss of vertebral body height (more than 25%), disc destruction (more than 50%), and the nerve compression.1 This scoring system may be an useful tool, mainly in developing regions with scarce resources to get expensive procedures and confirm the definitive microbiological agent.
