Tuberculosis of the spine is probably one of the earliest diseases to have affected the human race. Over the past few decades, the epidemiology, pathology, natural history and diagnostic methodology have been well studied. The multinational prospective study on the efficacy of conservative chemotherapy and surgical treatment coordinated by the Medical Research Council has just completed a final 15-year follow-up report. Although it appears from this study that conservative treatment is as effective as surgical intervention for earlier and milder diseases, there are still reservations on the effect of such treatment at much longer follow-ups and for more severe diseases. Further developments in diagnosis using molecular genetic techniques, more effective antibiotics and more aggressive surgical protocols in the next millennium may help in solving the problems of late severe deformity and paraplegia in the debilitated immunocompromised patients.