In spinal tuberculosis, which pattern of vertebral involvement is the most common?

• A Central lesion of the vertebral body with collapse
• B Anterior subligamentous lesion spanning multiple levels
• C Paradiscal lesion with narrowing of the adjacent disc space ✓
• D Posterior element involvement with neural arch destruction

Explanation

The paradiscal type accounts for roughly half of spinal tuberculosis cases. The bacilli seed the anterior part of the vertebral body adjacent to the end plate, where the blood supply is terminal, leading to end plate destruction and early disc space narrowing because the avascular disc receives nutrition from the destroyed vertebrae. Posterior element disease occurs in only a small minority of cases.

Reference: Textbook of Orthopaedics, Ebnezar, 5th ed.

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