The purpose of this study is to review of spinal tuberculosis in three hospitals in Isfahan of Iran. We carried out a cross sectional study of 630 patients with tuberculosis and identified 100 patients with spinal involvement in the three hospitals. Tuberculosis was diagnosed based on one of a compatible clinical picture. A radiographic study of the spine with suspicious signs and skin tested were performed for each patient. Demographic data, sign, symptoms and site of spinal involvement were recorded. In all patients, a chest X ray and sputum smear and culture was performed for rouling out of pulmonary tuberculosis. Out of the 100 patients with spinal tuberculosis, 58% were male and 42% were female. Main symptoms were spinal deformity, local tenderness and neurologic deficits. Fever and constitutional symptoms were in 80% of cases. Only 68% had a positive tuberculin skin test. Three percent involvement were the upper thoracic spine, 23% the lower thoracic spine, 69% also the lower thoracic, T12 and upper lumbar spines, (thoracolumbar) and 5% the cervical spine. 40 cases underwent bone biopsy that 25% had a positive smear, whereas 62.5% had a positive culture. Histologic findings suggestive of tuberculosis involvement of the bone were found in 37 of the 40 biopsies. The most common age for spinal involvement were 20-40 years (p < 0.05). Spinal tuberculosis may be missed in patients with no evidence of pulmonary. No pathognomonic imaging signs allow tuberculosis to be readily distinguished from other conditions. In this here, we discuss about clinical and histopathological findings in patients with spinal tuberculosis.