Background: Spinal tuberculosis is common in developing countries. It is always secondary to a primary lesion elsewhere in the body. Localized spinal pain is the most common presentation of this disease. It usually involves the anterior elements; hence surgery through anterior approach is the approach of choice. Material and Methods: This prospective observational study was conducted in the Department of Neurosurgery at Liaquat University Hospital Hyderabad/ Jamshoro from January 2010 to August 2011. A sample of forty patients was selected after obtaining informed consent for this study. Patients were admitted throughout patients department, Liaquat university hospital Hyderabad/ Jamshoro, casualty and referred from other department. All patients were investigated with magnetic resonance imaging (MRI) along with routine investigations.The data was collected on a predesigned proforma and SPSS 17 was used for data analysis. Results: Thirty two (32) patients improved neurologically and four (4) patients worsened while four (4) patients remained same. Conclusion: Patients having neurological deficits with large Para vertebral abscess and spinal deformity should undergo surgical intervention without any delay.