Tuberculous spondylitis is an infection involving one or more of the components of the spine, namely the vertebral body, intervertebral disc and ligaments, paravertebral soft tissues, and the epidural space. The causative organism belongs to one of the different strains of Mycobacterium tuberculosis. The role of CT and MR imaging in the diagnosis and management of tuberculous spondylitis is reviewed, and the differential diagnosis of these appearances is discussed. The possible impact of HIV infection on the number of reported cases and their mode of presentation also is considered. The need for prompt diagnosis is emphasized.