This chapter discusses tuberculosis of spine: differential diagnosis. The symptoms, signs and radiological findings of tuberculous disease of the vertebral column are often characteristic. In clinical practice, there are some cases whose final diagnosis is revealed only by examination of diseased tissue obtained by operation. Typhoid spine, brucella spondylitis, mycotic spondylitis, syphilitic infection of the spine, spinal osteochondrosis, spondylolisthesis, and hydatid disease are also covers in this chapter. Three main types of syphilitic infections of the spine have been described, arthralgic type of syphilitic spondylitis, gummatous type of syphilitic spondylitis and Charcot’s disease of the spine. The most common site of involvement is thoracolumbar and lumbar spine. Spinal osteochondrosis is an ischemic lesion of the apophysis of several vertebrae occurring in early adolescence. Miscellaneous conditions which may rarely resemble tuberculous infection of the spine are spondylolisthesis, ankylosing spondylitis, scoliosis, disk degeneration, osteoarthrosis, congenital short hamstrings, aortic aneurysm causing erosion of the vertebral bodies and Paget’s disease of the vertebra.