Abstract Background Thoracolumbar spine constitutes the most common site for spinal tuberculosis. Though the treatment of spinal tuberculosis is antitubercular drugs initially, the patient with neurologic weakness warrants definitive surgical procedure of decompression and stabilization. Even though many investigators have reported favorable results with anterior decompression and stabilization surgery, due to the increased morbidity and complications, the posterior-only approach with decompression and stabilization has evolved as the operation of choice in recent time. Methods All patients aged between 18 and 70 years with clinically and radiologically proven symptomatic thoracolumbar spinal tuberculosis who failed with conservative treatment for 4 weeks or developed neurologic weakness between the treatments are included in this study. All patients were offered decompression and posterior stabilization with transpedicular screws and rods after explaining the above procedure. Clinical outcome was measured by modified Frankel grading; AIS (American Spinal Injury Association impairment score) grade impairment score; and pain assessment done with visual analog scale (VAS) pre- and postoperatively and at 3, 6, and 9 months of interval. Results The postoperative pain relief, neurologic improvement as per modified Frankel grade, AIS grade, and improvement in erythrocyte sedimentation rate and C-reactive protein were significant as compared with the preoperative status. The surgical interventions thus prove to have adequate relief to the patient and arresting the disease progression. The surgical outcome has very minimal intra- and postoperative complications. Conclusion Single-stage decompression and posterior stabilization in thoracolumbar spinal tuberculosis is safe, effective, and results in good clinical outcome. The advantages of surgery include thorough debridement, decompression, and achievement of spinal stabilization.