ABSTRACT

Spinal tuberculosis (ST) is a chronic granulomatous infection caused by the hematogenous spread of Mycobacterium tuberculosis and represents one of the most common and severe forms of extrapulmonary tuberculosis, most frequently involving the thoracic and thoracolumbar spine. The non-specific clinical presentation, insidious onset, and slow progression of the disease often lead to delays in diagnosis. Magnetic resonance imaging (MRI) is the primary imaging modality for early detection, assessment of disease extent, and evaluation of associated complications. The most common pattern of involvement in ST is the paradiscal type, characterized by vertebral body destruction, narrowing of the intervertebral disc space, and paravertebral soft tissue involvement. Compared with pyogenic spondylodiscitis, disc involvement typically occurs at a later stage, which is an important feature in the differential diagnosis. Subligamentous spread, multilevel involvement, and large thin-walled paravertebral (cold) abscesses are characteristic imaging findings of ST. While computed tomography is superior in evaluating osseous destruction and calcifications, MRI remains the gold standard for assessing spinal canal involvement, epidural extension, and neural structures. Spinal cord compression, progressive kyphotic deformity, and neurological deficits represent the most serious complications of the disease.