Drug-resistance has emerged as amajor challenge in the management of tuberculosis as it can be associated with a mortality of up to 80%. A survey in 1997 found rates of resistant case of above 2% in about one-third of the countries surveyed. The MDR-TB spine, both primary and secondary, is a definitely rising problem. There is an urgent need for a greater awareness amongst orthopedic and spine surgeons. There should be standard recommendations on biopsy and drug-sensitivity testing. Qualified specialists, who have considerable experience in this rare but serious problem, should do the treatment of MDR. It is important to understand that the treatment of MDR-TB spine can be prolonged and poses significant financial burden to the patient and the society and has potential serious adverse effects. Based on their experience of managing drug-resistant tuberculosis spine, the authors recommend that mandatory drug sensitivity testing should be done in all patients with tuberculosis of the spine and there is a need for rapid diagnostic testing methods for MDR cases.