Case: Isolated Mycobacterium tuberculosis (TB) infection of the posterior element of a vertebra is rare, but timely diagnosis affords an opportunity for treatment before spinal cord compression occurs. A twenty-eight-year-old woman presented with bilateral weakness of the lower extremities. The clinical findings correlated with compressive myelopathy, for which the most likely causes include a primary tumor and infection. The diagnosis of TB was based on the magnetic resonance imaging findings, along with ultrasound-guided aspiration showing necrotizing granulomatous inflammation in a patient at high risk for TB. She was managed conservatively with an antitubercular treatment and achieved a good response at the latest follow-up at one and a half years.
Conclusion: Even with symptoms of spinal cord compression, some patients with TB infection of the posterior elements of vertebrae can be managed medically without surgery.