The last decade has seen a sharp rise in the number of osteoarticular tuberculosis (TB) cases in general and spinal TB in particular. With rapid advances being made in diagnostic modalities and chemotherapy, there has been a renewed interest amongst spine surgeons to understand the basic microbiological and pathological aspects of this universal disease. Tuberculosis is as old as man himself and has a long history. With the resurgence of TB spine, several new advances have been made and the war against TB has intensified! Though pharmacological and surgical nuances have a great role in this era, clearly it is the advances in diagnostic modalities that would raise the bar. Early and specific diagnosis would help physicians institute early therapy and that would help modify the natural history of the disease in a given case. Culture techniques like BACTEC and MIGT have all played a role in rapid diagnosis, but we are still looking for a “gold standard” laboratory test to diagnose TB in a full-proof manner. Until then image-guided biopsy followed by appropriate culture and drug sensitivity remains the best bet and the authors would strongly suggest that this is done as a protocol before start of treatment to minimize or eliminate treatment error.