Plain radiograph is the initial investigation to look for the presence of bony and intervertebral disc abnormalities.

Plain radiographs of the spine demonstrate changes suggestive of spinal tuberculosis in majority of the patients. The radiographic changes on plain X-Rays are not evident in the early stages of infection, therefore the changes are present in the late stages of the disease. Findings on the plain radiograph include:^[1][2]

• Rarefaction of the vertebral end plates
• Lytic destruction of anterior portion of vertebral body
• Collapse of the vertebral body
• Loss of disc height
• Osseous destruction with osteolytic lesions
• New-bone formation
• Soft-tissue abscess appear as fusiform paravertebral shadows : Increase in the prevertebral space in the cervical spine suggests retropharyngeal abscess, lumbar spine abscess appear as paravertebral soft tissue shadows.
• Presence of calcification in the abscess is highy suggestive of tuberculosis infection.