TB spine / tuberculosis in spine / Koch disease / infection in spine - A patient presented with severe back pain with difficulty in walking and sitting with weight loss. On MRI he is diagnosed with vertebral end plate damage with epidural abscess with compression of spinal cord. We did spinal fixation Surgery with titanium screws and rods with Spinal cord decompression with Epidural abscess drainage and biopsy of dead tissue and sample is sent to laboratory for examination. The Patient is sitting and walking on day 2 of surgery. Now he can walk and sit pain free and also do regular exercises. On biopsy report tuberculosis infection is diagnosed, so we started medicine for TB for 1 year. TB spine presented with severe back pain, Difficulty in sitting and walking, sometimes evening rise of temperature, loss of appetite and weight loss. On MRI and x-ray we can see vertebral end plate damage, epidural abscess, prevertebral abscess, spinal cord compression, disc damage and due to this sometimes the spine is unstable. Treatment includes diagnosis of disease whether it is TB or bacterial infection, sometimes may be fungal infection. Biopsy is advised in a stable spine and early stage of disease and treated conservatively with medicines. If spine is unstable then Spine fixation with titanium screws and rods with spinal cord decompression with epidural abscess / prevertebral abscess drainage is advised. After surgery patients can walk with a belt on the next day of surgery.