Background: Spinal tuberculosis (STB) often causes neurological deficits, kyphosis, or paraplegia. Anti-tubercular therapy is it’s mainstay of treatment modality and surgery is indicated for neurological deficits, abscess, or instability. This study evaluated the efficacy and safety of transpedicular decompression, fusion, and instrumentation for thoracic/lumbar tuberculosis. 
Methods: A prospective observational study was conducted in Bangabandhu Seikh Mujib Medical University, Dhaka, with a study period of 2.5 years. Twenty-seven patients meeting selection criteria were included. Pain, neurology, and function were assessed pre-operatively and at three weeks, three months, six months, and 12 months postoperatively. 
Results: Patient had a mean age of 43 ±17.47 years, with a male predominance (M: F ratio 1.5:1). Forty percent were from low-socioeconomic backgrounds. Neurological and functional improvement was statistically significant in 24 patients (96%). At the final 12-month follow-up, 88% achieved an excellent functional outcome; one patient had poor results without improvement. Complications included one case each of CSF leakage, postoperative hemorrhage, and surgical site infection. 
Conclusion: The study demonstrates that posterior transpedicular decompression with interbody fusion and instrumentation is a safe and effective treatment for thoracic and lumbar tuberculosis in Low-middle income countries (LMICs). It results in significant neurological recovery, substantial pain relief, and excellent functional outcomes in the majority of patients, with a low rate of postoperative complications. 
Keywords: Low-middle income countries, Posterior stabilization, Spinal fusion, Spinal tuberculosis, Transpedicular decompression