Posterolateral migration of complete vertebral body in neglected tuberculosis of the spine

The most common presentation of tuberculosis (TB) of the spine is paradiscal lesion secondarily involving adjacent disc and vertebral bodies. If not diagnosed early, it can lead to extensive destruction and atypical features. We report a patient who presented late with posterolateral migration of the vertebral body and multifocal spinal involvement. A 30-year-old female presented with back pain, progressive spinal deformity, and paraparesis. Plain X-rays, computed tomography scans, and magnetic resonance imaging revealed multifocal extensive TB of the spine with posterolateral migration of the first lumbar vertebra. The vertebral body showed erosions. Posterior elements involvements with pars interarticularis defects of 12th dorsal to 2nd lumbar vertebra were observed. The patient was planned for stabilization of the spine along with excision of the migrated vertebra along with antituberculous treatment, but she refused surgery. The authors discuss the pathogenesis of such a rare event and stress the early detection of this complication.