Aim And Background: Spinal involvement occurs in less than 1% of patients with TB but the increasing frequency of TB in both developed and developing countries continues to make spinal TB a health problem. Spinal TB (Pott’s disease) is the most common as well as most dangerous form of skeletal TB and accounts for 50% of all cases of skeletal TB. This study aims to study the prevalence of spinal tuberculosis and the effect of ATT based on clinical and radiological improvement. Methods: Observational study was done on patients who were started on AKT for spinal tuberculosis in Sir Takhtasinhji Hospital Bhavnagar, Gujarat during the period of 14 months (from January 2022 to February 2023). Results: Out of 439 patients with Extra pulmonary tuberculosis (EPTB) 39 (8.8%) patients were of spinal tuberculosis out of which 22 were female and 17 were male patients. The highest prevalence in the age group 21-40 (33%). CBNAAT was performed on pus aspirates and tissue samples from 32 patients. Mycobacterium tuberculosis (Mtb) was detected in 14 patients (36%), and rifampicin resistance was detected in 4 patients (10%) [1 patient was resistant to fluoroquinolones in single-lineage probe assay (SLPA)].35 patients started on DSTB, 4 started on all oral longer regimen, 1 containing Delaminid. A total of 15 patients were cured, 23 were still on treatment and 1 expired. Conclusion: In our study, we found that spinal tuberculosis accounted for 8.8% of all cases of EPTB. CBNAAT was positive in 36% of patients with spinal tuberculosis, and 10% of patients were resistant to Rifampicin. It can also detect resistance to Rifampicin, which is an important first-line anti-tuberculosis drug. If any sample like tissue, histopathology specimen, pus that is aspirable or approachable, then it should be obtained for CBNAAT testing. This will allow clinicians to start the patient on the most appropriate treatment regimen as soon as possible.