A 24-year-old farmer female was admitted to the Department of Neurosurgery with low back pain, no fever, cough, motor deficit, or any symptoms. Medical, surgical, family histories and physical examinations were unremarkable. The laboratory findings showed a white cell count of 9.8 x 103/muL, C-reactive protein concentrations of 20, erythrocyte sedimentation rate of 50 mm/1 h, 90 mm/2 h and tuberculin skin test was positive. X-ray films showed the collapse of the L1, L2 vertebrae, and L1-2 intervertebral space (Fig. 1). An abscess was observed at the L1-L2 vertebral level in lumbar magnetic resonance imaging (MRI) (Fig. 2). Chest X-rays and Sputum smear were negative. The patient was treated with anti-TB treatment (Isoniazid, Rifampicin, Ethambutol, Pyrazinamide) due to spinal TB findings on MRI (Fig. 3). After 40 days, the patient was diagnosed with grade 1/5 lower limb weakness, and bladder and bowel dysfunction, with no impairment in sensation, which predicts spinal infection. MRI confirmed these abnormalities and showed typical findings such as vertebral endplate destruction, bone marrow and disk signal abnormalities, and paravertebral or epidural abscesses (Fig. 3). Due to clinical manifestations and MRI spinal TB findings (Fig. 3), the patient underwent surgical debridement, interbody fusion and internal fixation with fibular autografting and supplemental posterior spinal stabilisation using a posterior-only approach. On post-operative follow-up, the treatment continued for 9 months, in addition to physical therapy for lower limb weakness. In the end, the patient returned to full motion with grade 5/5 in the lower limb, normal sensation, and no bladder or bowel incontinence. No recurrence was observed in the grafting area. Radiologically 2, 6 and 12 months, 14 years' post-operation, the patient had achieved full bony graft spinal fusion (Figs 4-6).