The current challenges in the management of spinal tuberculosis are not just cure of the disease but complete functional restoration with intact neurological function and the absence of deformity. Spinal tuberculosis is still the most common cause for kyphotic deformity in many parts of the world. In the developing world where tuber-culosis is rampant, nearly 80% of patients with spinal tuberculosis have at least a minimal kyphosis at the time of presentation. Prevention of deformity in tuberculosis should be the prime aim in the treatment of spinal tuberculosis as avail-ability of potent antituberculous drugs has made uncomplicated tuberculosis a medical disease. The severity of deformity in spinal tuberculosis depends on the extent of vertebral destruction, level of lesion and age of the patient with more severe deformities seen in children and in lesions involving the thoracolumbar spine. In children deformity may continue to progress during growth even after the disease is cured and they should be followed up till the completion of growth. The presence of two or more “spine at risk” radiological signs or “pretreatment” deformities of 30° are harbingers of severe late collapse especially in children. Surgical procedures performed in the active stage to prevent deformity are simpler and have less morbidity compared to surgical correction of estab-lished deformities.