Clinical Presentation and Diagnosis of Tuberculosis
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The main artery supplying the spine runs posterior of the vertebrae and at each level, two arteriae, one cranial and one caudal, supply the spine and run from posterior to anterior. Tubercle bacilli which disseminate through the blood stream follow the flow until they get lodged in the peripheral capillary bed, which in the case of the vertebrae, is in the posterior region of the vertebra. Here they replicate and this explains why the most common location of tuberculosis in the spine is anterior.
The speed in the flow of blood is drastically reduced in the capillary bed. The presence of tissue macrophages with ensuing phagocytosis initiates a local inflammatory process not feasible at the level of arteriae with the more rapid flow of blood.
