The treatment of tuberculosis has varied since the time of Hippocrates. Pott (1779) mentioned that, “The remedy for the dreadful disease consists merely in procuring a large discharge of matter.” With the introduction of antiseptic and aseptic surgery, direct surgery on the lesion was attempted. Hadra (1891) performed stabilization by wiring the spinous processes. This was more widely used after Hibbs described his fusion method in 1911. At the turn of 20th century, a change occurred in the treatment of tuberculosis. Patients were often moved to sanatoria and treated with “fresh air and sunshine”. The nonoperative treatment was strengthened by the discovery of antituberculous drugs. Streptomycin was the first effective drug introduced in 1945, Para-aminosalicylic Acid in 1946 and isoniazid in 1951. These drugs were found to enter the abscess cavity and other infected tissues in the tuberculous lesion. Most surgeons were dissatisfied with the results of nonoperative treatment. Many of them developed procedures to decompress the spinal cord. Alexander and Dott described costotransversectomy in 1947. In 1954, Capener developed lateral rachotomy and Griffiths described the anterolateral approach. Anterior approach to the spine was first described by Ito et al. in 1934. This approach was popularized by Hodgson and Stock in 1956. Hence three philosophies of treatment existed at the same time. One was bed rest with antituberculous therapy and drainage of abscesses alone was done if necessary. The second group believed in local excision of the disease and anterior fusion to stabilize the spine. Tuli from Varanasi advocated a “middle-path” regime that consisted of administration of antituberculous drugs with bed rest. Surgical intervention was reserved for patients with complications or those who failed to response to drugs.The goals of management are to eradicate the infection, prevent or treat kyphosis and the neurological deficit. The patient should return to normal activities as soon as possible.