Treatment was instituted based on clinicoradiographic findings of the disease alone. Biopsy and possible operative treatment were reserved for patients who failed to respond to chemotherapy, have substantial neurological impairment, or in whom either resistant strains or other disease entities are suspected. However, the need for evidence-based practice makes biopsy mandatory, to confirm the diagnosis, detect antibiotic sensitivity and for documentation purposes. Instituting antitubercular treatment in a patient based on a presumptive diagnosis without histopathological confirmation exposes him to the side effects of toxic drugs as well as adds-on to the financial burden. Hence, all patients with suspicious features on clinicoradiological examination should be subjected to a biopsy prior to the initiation of treatment. Most biopsies can be safely and rapidly performed under local anesthesia in a sterile environment. Meticulous technique, knowledge of the spinal anatomy and indications and contraindications, and awareness of possible complications are essential for success.