In addition to the assessment of clinical features, other investigations are often needed to supplement clinical suspicion of spinal tuberculosis. Often, the rationale of investigation is more on the lines of exclusion, i.e. to eliminate noninfectious lesions, as also other infectious lesions since there exist a host of pathologies including malignancy that can masquerade as tuberculosis. Though there exists a plethora of tests, the exact choice of investigations as also the sequence of investigations may vary depending on available resources. As a result, there are no universally acceptable guidelines available as to how to optimally utilize diagnostic tests ranging from simple blood investigations, such as the erythrocyte sedimentation rate to the more advanced techniques of molecular biology, such as polymerase chain reaction. Despite such a wide array of diagnostic tests, it is not possible to get bacteriological, histopathological or other forms of confirmation of diagnosis for tuberculosis in about 31 to 39% of cases. Biopsy and culture necessitate invasive procedures that are not always definitive, and may require repeated attempts. In many instances, corroborative evidence of multiple investigation reports would lead to the correct diagnosis rather than relying only on one or two tests. In fact, satisfactory clinical and biochemical response to antituberculous treatment can itself be considered as a corroborative evidence for the diagnosis of spinal tuberculosis.