Introduction:
Spinal Koch involving posterior elements of the neural arch is one of the atypical presentations which are often missed.
Case presentation:
A 40-year-old female presented with radiculopathy and bilateral lower limb claudication for 5 months. Radiological investigations showed compressive lesion resembling flavum hypertrophy and a degenerative etiology was thus suspected. However, histopathology report pointed toward tuberculosis (TB) of the posterior elements (atypical form). Management with surgical decompression and anti-Koch treatment gave a successful outcome.
Conclusion:
TB affecting posterior elements of spine is a rare entity and needs a high degree of suspicion for accurate diagnosis. Newer radiological interventions such as computed tomography and magnetic resonance imaging along with histopathological evidence will help to clinch the diagnosis of Koch's spine early before neurological problems or deformity sets in. Keeping a high index of suspicion will help to avoid missing the atypical forms of the disease.