“T†For Tuberculosis, “T†For Tumour, “T†For Tension

Low back ache is one of the most common complain of patients reporting to any Orthopaedic outpatient department. After exclusion of post traumatic, osteopenic and inflammatory arthropathy for chronic back ache, the bulk of the etiology is either tuberculosis or anaplastics (metastasis being the most common anaplastic condition).In my country, due to the increased prevalence of Tuberculosis and the practical acceptance of trial first line Anti Tubercular Therapy, it is the first diagnosis that comes to our mind while anaplastic conditions are our last bet. More often than not, on getting the traid of constitutional symptoms, spondylodiscitis and raised ESR, we start trial first line ATT, forgetting that the features of TB and anaplastics may mimic each other. Only after failure to respond to trial first line ATT, we go for Gene Xpert test (for Drug resistance tuberculosis), biopsy (for tuberculosis or analytics) and tests for the work up of metastasis of unknown origin to check for Drug Resistance TB or anaplastics.