Summary Antituberculous medication for treatment of tuberculosis has been used for nearly a half century. However, tuberculosis of the spine still shows up from time to time in the developed countries and it is still a common scourge in half of the world today. The author reviews his treatment of tuberculosis of the spine over 30 years' full-time work in developing countries. He gives an analytical breakdown of his first 10 years of operating on 236 cases, both paralytic and nonparalytic. Changes in treatment developed with experience. Posterior spinal fusion gave good results. Radical evacuation of the abscess alone gave poor results. Best results were obtained in the combination of the two. This surgery provided a stable, pain-free spine and shortened period of time that antituberculous medication was required. A true lateral approach for spinal decompression was developed and is described. This procedure can be performed by ordinary orthopedic teams in developing countries. It is safer than the transthoracic approach and gives better exposure.