Tuberculous spinal osteitis
This usually occurs in children and young adults, but no age is exempt. It is now much less common in developed countries than in the past.
Tuberculous spinal infection is still common in less developed regions of the world. The thoracic cord is most commonly affected. The infective process generally begins in the vertebral body and spreads to adjacent bodies, leading to their collapse and an angular deformity of the spine.
It is rare for the deformity as such to be a major factor in compressing the cord, which is more often affected by an extradural tuberculous abscess or tuberculous meningomyelitis. In addition to actual cord compression, which may, however, be absent, interference with the vascular supply of subjacent segments, either by compression of radicular arteries or by endarteritis, is an important factor in producing paraplegia.
These considerations probably explain the good outcome that can be achieved by conservative treatment using antituberculous chemotherapy rather than surgical decompression, even in severe cases.
Syphilitic spinal osteitis is now a very rare cause of spinal compression and produces effects similar to those of tuberculous caries.