This chapter discusses tuberculosis of spine: neurological deficit. Tuberculosis of spine is the most common and dangerous form of skeletal tuberculosis and it constitutes 50% of osteoarticular tuberculosis. The dorsal spine is affected in 50% cases of spinal tuberculosis while lumbar and cervical spine in about 25% each. This chapter discusses staging of neural deficit, clinical presentation of tuberculous affection of spine, imaging of tuberculous spine, and prognosis in tuberculous para/quadriplegia, craniovertebral tuberculosis, and spinal tumor syndrome, cervical spine tuberculosis with neurological deficit, neurological complication with healed disease, management, and treatment. Tuli treated these cases by Crutchfield tong traction and complete antitubercular drug therapy. The patient of cervical spine tuberculosis with neurological complications should be treated with Crutchfield tong traction/ with complete ATT. Anterior decompression with removal of internal Gibbus is the treatment in such cases though it seldom produces complete recovery of paraplegia as compared to paraplegia with reactivation and fraught with complication of deterioration of neural deficit.