A 35-year-old presents with progressive kyphosis, fever, and lower limb weakness. MRI shows vertebral body destruction predominantly at the anterior column of two adjacent vertebrae with a large paravertebral abscess and disc space loss. The most specific radiological sign of tubercular spondylitis distinguishing it from pyogenic spondylodiscitis is:

• A Large anterior paraspinal (psoas) abscess disproportionate to vertebral destruction ✓
• B Preservation of the intervertebral disc space in early disease
• C Rapid destruction of vertebral end plates within 2 weeks
• D Involvement of only one vertebra (monovertebral disease)

Explanation

Tubercular spondylitis characteristically produces large paraspinal/psoas abscesses that are disproportionately large relative to bone destruction — a distinguishing feature from pyogenic spondylodiscitis where abscess is usually smaller. TB also spares the disc early (avascular cartilage is resistant to TB), causing disc destruction late, unlike pyogenic infection which rapidly destroys the disc (disc is rich in proteoglycans). Skip lesions (non-contiguous involvement), posterior element involvement, and anterior column destruction producing angular kyphosis (Pott's disease) are other TB features.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.