Chronic back pain is an extremely common complaint. All primary care physicians will be on the lookout for the 'red flags' that suggest serious pathology. The diagnosis of spinal infection with tuberculosis (TB) is uncommon and often not considered, especially in areas where the rate is very low such as the south west of England. We describe a patient presenting to the emergency department with severe pain, immobility and with a sensory deficit level. Unfortunately, given the favourable results for early medical treatment for spinal TB, this patient presented late and had a very poor outcome.