BACKGROUND: Few studies have described children with spinal multidrug-resistant tuberculosis (MDR-TB). Treatment involves surgery and medical care with long courses of drug therapy. METHODS: Hospital and laboratory records at Brooklyn Chest and Tygerberg Children's Hospitals, Cape Town, South Africa, were analysed (January 2004 until December 2010) searching for children treated for MDR spinal TB. RESULTS: Of the 11 children identified, 4 were excluded. Of the 7 remaining, 5 were boys; median age: 8 years, median delay to treatment initiation: 36 weeks. Among them one child died, five have completed treatment and one is near the end of therapy. Medications were well-tolerated and although two of the surviving children have spinal deformity, none have significant neurological deficit. CONCLUSIONS: The diagnosis of spinal MDR-TB is often delayed in children, frequently leading to advanced disease and severe vertebral damage. Children tolerate therapy well and, once identified, it is a condition that can be treated successfully.