Background Tuberculosis of the spine is the most common form of bone and joint TB, affecting biology, mechanics, and neurology. Treatment strategies have evolved from watchful waiting to aggressive debridement, and now to selective surgery based on well-defined principles Methods We treated 20 spinal tuberculosis patients: 10 with extensive abscesses (3 with kyphosis) and 10 in the early phase with minimal abscesses and cord compression. All received surgery for debridement, stabilization, and concurrent antituberculous chemotherapy. Results All patients achieved infection eradication and successful fusion. Early intervention led to better outcomes, with all patients reaching ASIA E, while late surgery showed slower recovery. Late surgery had longer hospital stays (25 days), higher costs, and MDR-TB complications. Early surgery had shorter stays (8 days) and better responses to standard ATT. Conclusion Our study supports early surgical intervention for Koch's spine, leading to better neurological recovery, shorter hospital stays, improved pain management, faster mobilization, and cost-effectiveness. Early surgery is key to optimizing outcomes.

Spinal Tuberculosis, antituberculous chemotherapy, neurological recovery