[Objective] A delay in the diagnosis of tubercu- lous spondylitis can result in worsening of the condition. We investigated previously reported cases of tuberculous spondylitis, as well as cases experienced in our hospital, to identify factors that are useful in the diagnosis. [Materials and Methods] We retrospectively evaluated six cases of tuberculous spondylitis diagnosed in our hospital between October 2007 and September 2012, and an additional 23 cases that had been reported in Japan between 1994 and 2014. [Results] The median age of our six patients was 78.5 years and five were women. In all cases, the focal lesion was seen in 2-3 adjacent vertebrae; four patients had miliary tuberculosis and five had lower back pain. All patients received oral treatment for 10-12 months. Among the 23 patients previously reported, 57% were women, and a focal lesion was found in 2-3 adjacent vertebrae in 86%. In addition, 57% had miliary tuberculosis and 65% had lower back pain. A personal and family history of tuberculosis was found in 20% and 26%. [Discussion] Radiographic assessment and microbiological testing of areas other than the chest and spine are useful in the diagnosis of tuberculous spondylitis. Furthermore, lower back pain, lower extremity symptoms, and personal and family history of tuberculosis are important factors. [Conclusion] When tuberculous spondylitis is suspected, diagnosis may be possible by investigating focal lesions in areas other than the spine.