Skeletal tuberculosis is a common problem in India and among the developing countries of the world. Of all musculoskeletal tuberculosis, spinal tuberculosis is the commonest. The goals in the management of TB are eradication of disease, preventing the progression of spinal deformity and neurological deficit. The anatomic variations of spine with changes in canal dimensions in different spinal segments lead to varied outcome. Craniocervical, cervical, thoracic, thoracolumbar, lumbar and lumbosacral tuberculosis all have their specific peculiarities. This chapter attempts to focus on lumbosacral tuberculosis which usually includes spine below the third lumbar vertebrae. Up to 10% of cases of spinal tuberculosis have neurological deficit. Rest of them, if not properly and promptly treated, can develop long-term morbidity.