Spinal intradural tuberculosis occurs in conjunction with tuberculous spondylodisciitis or with intracranial tuberculous meningitis. Rarely, it may occur in the absence of either vertebral or meningeal TB. Spinal intradural TB can arise from direct extension from the vertebrae or as downward extension of intracranial meningitis. Infrequently, it occurs primarily in the spinal meninges, presumably through a hematogenous route of infection. The outcome of treatment for intraspinal TB has been unpredictable, with some authors reporting a good outcome and others an unfavorable outcome following surgical decompression. Some reports describe a good outcome with only medical management with antituberculosis medication and steroids. In general, patients with syringomyelia have a poorer outcome, those with an intramedullary lesion have a more favorable outcome and those with severe arachnoiditis and extensive lesions have an unpredictable outcome.