<![CDATA[causing severe biomechanical instability and neurological morbidity, particularly in endemic regions due to delayed diagnosis. This review synthesizes current evidence on the epidemiology, pathogenesis, diagnosis, and neurosurgical management of STB. Its insidious disease course often leads to advanced vertebral destruction, cold abscesses, and progressive kyphosis before clinical detection. MRI remains the radiological gold standard. For definitive diagnosis, integrating GeneXpert MTB/RIF and histopathological biopsy is crucial given the paucibacillary nature of the infection and the rising threat of multidrug-resistant strains (MDR-STB). Management follows the "Middle Path" philosophy, balancing long-term antitubercular therapy (9–18 months) with surgical intervention. Neurosurgery is indicated for progressive neurological deficits, three-column instability, or severe kyphosis (>40°). Currently, the posterior-only approach with pedicle screw fixation is preferred for its robust stabilization and lower perioperative morbidity. Successful STB management requires a multidisciplinary approach, expanded access to rapid molecular diagnostics, and strict adherence to surgical indications to prevent irreversible neurological sequelae. Keyword: Spinal Tuberculosis, Pott's Disease, GeneXpert, Spinal Fusion, Antitubercular Therapy.]]>
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