Aim: Assessment the role of MRI in the treatment of spinal tuberculosis. Material and methods: This study was conducted in the Department of Radiodiagnosis, where MRI case records of 50 patients with confirmed spinal tuberculosis were retrospectively reviewed. Along with the MRI findings, relevant clinical histories were documented. The diagnosis of spinal tuberculosis was based on a combination of clinical history, physical examination, and various investigations. These investigations included Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), sputum cytology, histological demonstration of acid-fast bacilli in the lesion, and the growth of Mycobacterium tuberculosis on tissue or ascitic fluid culture. Additionally, a satisfactory therapeutic response to anti-tubercular treatment in patients with clinical, radiological, or operative evidence of spinal tuberculosis further supported the diagnosis. Results: Intradural involvement was noted in 20% of the cases, while intramedullary involvement was less common, affecting 10% of the patients. Multiple compartment involvement was also observed in 10% of the patients. The extent of vertebral involvement was assessed through MRI, revealing that 70% of the patients had vertebral body involvement, making it the most common site affected by spinal tuberculosis. Posterior element involvement was observed in 30% of the patients. Wedging or compression of vertebrae was seen in 50% of the cases, indicating the potential for spinal deformity. Involvement of intervertebral discs was noted in 40% of the patients, and subligamentous extension was present in 36%. Abscess formation is a critical feature of spinal tuberculosis, and the study found that paravertebral abscesses were the most common, occurring in 40% of the patients. Epidural abscesses were seen in 30% of the cases, while psoas abscesses were present in 20%. Notably, 10% of the patients did not have any abscess formation. Conclusion: Overall, the study results demonstrate the complex nature of spinal tuberculosis, with varied clinical presentations and significant involvement of spinal structures as revealed by MRI. The findings underscore the importance of early diagnosis and comprehensive imaging to guide effective treatment strategies.