This is a 42-years old man with backache. MRI shows an L3/4 lesion with anterior soft tissue. The findings are unusual for TB and more suggestive of an infective bacterial disciitis, but without a biopsy and microbiological proof, it is not possible to differentiate tuberculosis from non-tuberculous etiologies.

Rule: Every infectious spondylitis has to be biopsied.

The biopsy was simple using an 18G coaxial biopsy gun introduced into the anterior soft tissue. The etiology was MSSA – methicillin sensitive staphylococcus aureus infection.