Tuberculosis of Spine - Post Tubercular Kyphosis This 8 year old boy presented to us with history of back pain since last 4 months and progressive deformity of back. His MRI showed destruction of D12 and D11 vertebrae with paraspinal abscess and local Kyphosis. He had undergone biopsy at another centre and was diagnosed as MDR TB. He was on regular treatment with 2nd Line Antitubercular Medication for last 2 months. However Parents noticed that the deformity was gradually progressing. So in view of young Age, progression of deformity and chances of further detoriation , parents were counselled that the boy needs decompression with Pedicle screw fixation, Kyphosis correction and Anterior Interbody fusion with either Bone graft or cage. Also as the disese was active it would be easier to correct deformity now rather than when disease has healed up. Surgery in this case was challenging as pt was neurologically intact and had very thin built. Because of his thin built even paediatric pedicle screw were too big for him and there were chances of screw prominence through skin. So we used Adult cervical Lateral mass screws for fixation. Patient underwent posterior laminectomy and lateral mass screw fixation in his pedicles . At D12 transpedicular decompression was done . we did not do any rib resection or nerve resection and placed 16 mm Adult titanium Bullet TLIF cage anteriorly with bone graft to correct and preserve Kyphosis. Pt was kept in ICU for overnight observation. He was mobilsed with brace and discherged on 3 rd day. Parents have been counseled to keep mobility at minimum to prevent implant failure till we achieve fusion