Introduction Tuberculosis is one of the oldest diseases of the mankind. Skeletal involvement is seen in approximately 10% of all patients with extra pulmonary TB. Spinal TB constitutes 50% of all extra pulmonary TB. It most commonly affects lower thoracic and thoracolumbar regions followed by the lumbar and cervical regions. Aims and Objectives To analyse the results of outcome of the patients with spinal tuberculosis who presented with us over a period of one year from 2015 to 2016 in a single neurosurgery unit in Government Medical College Thiruvananthapuram, Kerala, India. Materials and Methods In this retrospective study, all consecutive patients with diagnosis of spinal tuberculosis from January 2015 to December 2016 were enrolled. This comprised of 14 patients. All patients underwent MRI prior to admission. The diagnosis was based upon clinical suspicion supported by radiological evidence. The patient characteristics and radiological parameters were entered into database and analysed using SPSS trial version. Neurological assessment was done using Asia scale at admission, after surgery and at discharge. Patients who presented with neurological deficits underwent surgery with posterior decompression with transpedicular fixation. Outcome was assessed with improvement in ASIA scale in patients with neurologic deficit and improvement in VAS scale in patients who presented with back pain. All patients were given DOTS 4 drug regimens and were followed up regularly. Any drug related complications were recorded and managed accordingly. Results There were total 14 patients of 8 were males and 6 females. 6 patients presented with acute neurologic deficits and 2 with instability, all of these patients underwent posterior decompression and fixation. All 14 patients were given DOTS 4 drug regime which constituted of HRZE in intensive phase of 2 months and followed by 2 drug HR in continuation phase for 7 months. All patients had their blood profile monitored for any intolerance to ATT and also to monitor for the response to treatment. Out of 8 patients who underwent surgery, 3 had excellent outcome, 2 had good outcome,1 had fair outcome and 2 died. The remaining 5 who presented with back pain had significant improvement in VAS score at the end of the treatment. Conclusion TB spine constitutes a diagnostic dilemma at many occasions. Early decompression can reverse neurologic deficit. DOTS with posterior decompression and fixation offers a good option in the management of tuberculous spondylodiscitis who present with acute neurologic deficit whereas in ambulant patients intermittent DOTS gives good pain relief with healing at the end of the treatment.