Spinal tuberculosis (STB) is the most common form of osteoarticular tuberculosis, accounting for 50% of all skeletal involvement.1 The mainstay of management of STB is based on antitubercular chemotherapy (ATT), whereas surgery is preserved to prevent or treat complications such as neurologic involvement, instability, deformity, and presumptive drug resistance.2,3 Surgical approaches to be considered may include anterior, posterior, or combined. For kyphosis correction, the posterior approach with improved instrumentation is associated with less morbidity and fewer complications compared with the anterior approach.4,5 The drugs used during the treatment have their own complications, which need to be monitored throughout the whole course. Although there is a plethora of studies on the surgical management of STB, no clear guideline exists in the literature to guide its medical management.6, 7, 8 Deciding an end point of ATT in STB has always been a matter of debate. In contrast to pulmonary tuberculosis (PTB), in which chemotherapy duration is 6 months (2 months intensive phase + 4 months continuation phase) in drug-sensitive cases,9 there are no clear guidelines on the duration of chemotherapy in STB. Most of the existing literature vouches for an extended course of ATT for 18–24 months depending on treatment response.10,11 Some studies favor short-course chemotherapy of 6 months.12 The controversy is attributed to no defined end point of STB healing. Furthermore, in PTB, the end point of ATT is defined by a sputum smear-negative report,9 but no definitive end point exists for STB. Lack of definite immunologic or serologic markers of healing, a confusing imaging picture in the evolution of disease during treatment with ATT, discrepancies in clinical and radiologic response to ATT, and the absence of any definite guidelines for extrapulmonary tuberculosis make it more difficult for physicians to decide when to declare a tuberculous spine lesion to be healed and when to stop ATT. In the process, patients suffer either from nonhealing with an insufficient treatment course or from toxic side effects of ATT over a long duration. The current systematic review is the first attempt to address the controversy existing in the literature and define the healing end point in STB.