The patient came to the clinic 23-March-2016 complaining of inability to walk for 3 weeks. She was treated elsewhere for abscess evacuation without sending for investigations 02-December-2015. The abscess discharge continued and suspicion for tbc was raised and started treatment for tbc. CT-scan of the chest performed 19-March-2016 showing extrapleural collection of pus over the left lung. Previous X-rays showed larger puss collection in this area. She was sent from the other hospital for investigations and she was under treatment with INH, Rifampicin, EMB, PZA and Amikacin. 

On examination: the patient walking with difficulty. There is weak grip both hands -4/5, extension both hands 3/5 both triceps 2/5. Weak right quadriceps -3/5 and left 3/5. Adduction of knees 4/5, abduction both knees 3/5. Dorsiflexion both feet 2/5 and planterflexion both feet 3/5. There is analgesia below the D3 dermatome. Babinski was positive both sides. No micturition or defection problems. 

The patient was sent for MRI cervical and dorsal spine and which was preformed 24-March-2016 showing complete destruction of C7 and D3 with epidural abscess in the left side pushing the spinal cord to the right and having continuity with the extrapleural abscess in the apical part of the left lung. The epidural abscess was extending from C5 down to D4.

Skeletonization of C4-5-6-7, D1-2-3-4-5 with maximal preservation of the viable bony and ligamentous elements. During dissection pussy material was coming from all corners both sides. The left side of C7 and D3 were completely destroyed by osteomyelitic changes and intraossal pus formation. All specimens were sent for thorough histologic and lab investigations. Inspection for remnants epidural abscess was negative the dura became lax and free fulfilling the canal. Using OASYS system with 14 sublaminar hooks of different sizes and directions with bended 3.5mmx20 cm length adapted to accept the natural curve of the area, fusion of C5,6, D1,2,4 and D6 was achieved using a healthy bone for fixation. Check for stability of the spine and construct was acceptable.  Routine closure of the wound.

Smooth postoperative recovery. The power of four limbs improved dramatically after surgery. She was sent to the ward.

The patient having an active TBC of the bones with pending escalation of tetraplegia. Surgical debridement and spinal decompression and fixation is mandatory to prevent this catastrophic event.

Treatment of tb of the bony spine tb must be extended at least for 5 years.