Tuberculous spondylitis (TB spondylitis) is the most common and serious form of extrapulmonary TB disease that attacks the musculoskeletal system. This study will identify and analyze predictive factors related to clinical outcome in TB spondylitis patients which include age, comorbid disease, time from symptom onset to diagnosis, back pain, leg weakness, numbness in legs, incontinence, level of lesions on MRI, leukocyte, ESR, and CRP values, as well as PCR and BTA results. This study will be an analytical study with a retrospective cohort approach, at the Haji Adam Malik General Hospital, Medan from January 2015 to December 2020. The inclusion criteria were all patients diagnosed with TB spondylitis and treated with anti-Tuberculosis (OAT) drugs. patients that died from other causes while on treatment and loss to follow-up were excluded. The sample size in this study was 171 patients and using the multivariate logistic regression analysis to identify predictive factors of poor outcome in TB spondylitis patients. On 184 study subjects consisting of 89 men (48.4%) and 95 women (51.6%). Good clinical outcome was obtained in 151 patients (82.1%), while 33 patients (17.9%) had poor clinical outcome. There is a significant relationship between numbness in the limbs (n = 29; 2 good outcomes (6.9%); 27 poor outcomes (93.1%); p = < 0.001), and the ESR value (mean 18.5 mm/hour; range 7-46), had a significant relationship with the clinical outcome of TB spondylitis patients and were identified as predictive factors for poor clinical outcome. The multivariate logistic regression analysis only numbness in the legs had a significant relationship with the patient's clinical outcome. ESR is a basic laboratory value and is used in general clinical practice to evaluate an inflammatory condition, eg infection . In this study, higher ESR values were found in patients with poor outcomes than in patients with good outcomes. Multivariate logistic regression analysis identified leg numbness and ESR scores as predictive factors for poor clinical outcome in TB spondylitis patients, with the greatest strength of association being ESR scores.