Tuberculosis of Spine in Children This 9 year old girl presented to us with progressive back pain for the last 5 months. She also had difficulty walking with weight loss. Her back showed a bony prominence in the lower spine. Her MRI and Xray showed complete collapse of L4 Vertebrae with a soft tissue component. She underwent surgery - all posterior approach. Used paediatric screws for fixation, did laminectomy and L4 Pedicle on left side was completely taken out to expose L3 and L4 nerve roots. For anterior column reconstruction and achieving lordosis - adult TLIF cage of size 14 was negotiated in between the nerve roots and placed into anterior disc space along with bone graft. This was followed by Posterior compression between the Pedicle screws. Biopsy proved to be MDR TB. The patient was started on ATT from DOTS. At 9 months follow up patient is pain free and walking comfortably. Parents have been counselled about the need for implant removal once fusion and TB treatment is complete.