Progressive destruction causes the vertebrae to wedge, resulting in a characteristic "gibbus" or kyphotic deformity (hunchback). "Cold abscesses"—named for their lack of typical inflammatory heat or redness—can form around the lesion and track into adjacent soft tissues, such as the psoas muscle in the lumbar region. Clinical Presentation and Diagnosis

The infection often begins in the anterior part of the vertebral body. As the bacteria multiply, they cause granulomatous inflammation and caseating necrosis, leading to the destruction of bone and the collapse of intervertebral discs.

Spinal tuberculosis usually originates from a primary infection focus, most commonly in the lungs, and spreads to the vertebrae through the bloodstream via the arterial or venous systems (such as the valveless Batson’s plexus).