This study aims to explore the clinical and CT imaging features of brucellosis spondylitis (BS) and to strengthen the clinical cognition to reduce misdiagnosis and mistreatment. In this study, clinical and CT imaging data of 106 patients with BS diagnosed in the Second Hospital of Hohhot and the Third Hospital of Baotou were collected from March 2023 to September 2024 and retrospectively analyzed by clinical manifestations, CT imaging, and disease regression. In 106 patients, 58.5% had fever, 98.1% had malaise, 96.2% had excessive sweating, 81.1% had lumbosacral pain, 79.3% had limitation of limb movement, 76.4% had constipation, and 6.6% had urinary retention. For imaging manifestations, the involvement of lumbar, thoracic and cervical vertebrae were 80.2%, 16.9% and 1.9%, respectively. Lesions < 1.0 cm, 1.0–2.0 cm, 2.0–3.0 cm, and > 3.0 cm were found in 49.4%, 29.6%, 19.4%, and 1.6%, respectively. In 106 patients, CT showed round, irregular or worm-like areas of bone destruction, with coexisting osteophytes in 61.5% and no signs of dead bone or pedicle destruction. Interdiscal destruction, spinal canal abscess, ligament injury, and signs of lumbar major muscle compression were rare, accounting for 11.7%, 6.6%, 4.7%, and 3.8%, respectively. Regarding regression, 106 patients with BS treated with antimicrobial therapy or antimicrobial + surgery had a good prognosis. In conclusion, BS has its own characteristics in clinical and imaging aspects and it is easy to distinguish from other common causes of spondylitis bone damage.