Neglected spinal tuberculosis with severe kyphosis is uncommon. Spinal tuberculosis can present with back pain, neurological deficits, cold abscesses, or severe deformities. Diagnosis is made using laboratory, imaging, and tissue studies. Management can be done medically or surgically. As neurological deficits or severe deformities worsen, most surgeons prefer a surgical option. There have been different opinions regarding the surgical approach for spinal tuberculosis. This is a case of neglected spinal tuberculosis with severe kyphotic deformity treated with single-stage posterior instrumentation and fusion without any complications within in a three-year follow-up period.