Characteristically, the earliest radiological sign of spinal tuberculosis on plain X-ray is:

• A Vertebral body collapse with posterior scalloping
• B Loss of disc space (narrowing) with erosion of adjacent endplates ✓
• C Paraspinal soft-tissue shadow (cold abscess)
• D Anterior wedging of the vertebral body

Explanation

Spinal TB begins as an anterior paradiscal (peridiscal) infection — the most common type. The earliest radiological change is loss of disc height due to disc destruction by tubercular granulation tissue, accompanied by erosion of the opposing vertebral endplates ('nibbled appearance'). This distinguishes spinal TB from pyogenic spondylodiscitis (similar X-ray early on) and from malignancy (discs spared in metastatic disease). Paraspinal shadow and vertebral collapse are later features. MRI is the investigation of choice for early diagnosis.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.