The lower thoracic and upper lumbar vertebrae are the most commonly affected in spinal TB. In most cases, the infection originates outside of the spine. It is most commonly transmitted through the blood from the lungs. Osteomyelitis and infective arthritis are both present. More than one vertebra is usually involved. The anterior section of the vertebral body next to the subchondral plate is the most damaged. TB may spread from that site to neighboring intervertebral discs. In adults, disc disease is secondary to infection spreading from the vertebral body, but in children, because the disc is vascular, it might be a primary site. It is the most prevalent site of tuberculosis in the skeletal system, though it can also affect the hips and knees. The infection spreads into the neighboring disc space from two adjacent vertebrae. The disc is okay if only one vertebra is afflicted; however, if two are involved, the disc between them collapses because it is avascular and cannot get nutrition. Caseation occurs, resulting in vertebral constriction, vertebral collapse, and spinal injury. A dry soft tissue mass frequently occurs, and superinfection is uncommon.
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