STUDY DESIGN: Prospective study. PURPOSE: We present a series of 50 patients with tuberculous cord compression who were offered systematic non-surgical treatment, and thereby, the author proposes that clinico-radiological soft tissue cord compression is not an emergency indication for surgery. OVERVIEW OF LITERATURE: Spinal cord compression whether clinical or radiological has usually been believed to be an indication for emergency surgery in spinal tuberculosis. METHODS: Fifty adults were prospectively studied at our clinic for spinal cord compression due to tuberculous spondylitis, between May 1993 and July 2002. The inclusion criteria were cases with clinical and/or radiological evidence of cord compression (documented soft tissue effacement of the cord with complete obliteration of the thecal sac at that level on magnetic resonance imaging scan). Exclusion criteria were lesions below the conus level, presence of bony compression, severe or progressive neurological deficit ( Adult ; Child ; Conus Snail ; Emergencies ; Evoked Potentials, Somatosensory ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neurology ; Prospective Studies ; Spinal Cord Compression ; Spondylitis ; Tuberculosis* ; Tuberculosis, Spinal