The spine is involved due an hematogenous spread via the venous plexus of Batson 2. There is usually a slow collapse of one or usually more vertebral bodies, which spreads underneath the longitudinal ligaments. This results in an acute kyphotic or “gibbus” deformity. This angulation, coupled with epidural granulation tissue and bony fragments, can lead to cord compression. Unlike pyogenic infections, the discs can be preserved. In late-stage spinal TB, large paraspinal abscesses without severe pain or frank pus are common, leading to the expression “cold abscess”.
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