Paediatric Tuberculous spinal abscess causing compression at the lumbar level

Incidence of paediatric spinal tuberculosis (TB) is increasing. Paediatric spinal TB is known to cause rapid bony destruction and deformity progression. We present a 4-year child with lumbar kyphotic deformity, progressive lower limb weakness and early bladder involvement. Imaging revealed near complete destruction and retropulsion of L4 vertebra with spine at risk signs. Posterior decompression, L1 to S1 fixation with pedicle screws and punching the remaining L4 body ventrally was performed. With aggressive post-operative physiotherapy and AKT patient recovered neurologically from Frankel C to Frankel E grade with complete radiological resolution of disease at final follow-up of 1 year. No further progression of deformity was observed at final follow-up. Conclusion: Early diagnosis, timely and judicious surgical intervention is the key to management of paediatric spinal TB.