The risk of persistence and recurrence of infection in posterior spinal instrumentation surgery for spinal tuberculosis was studied clinically and microbiologically. Eleven patients with thoracic, thoracolumbar, and lumbar spinal tuberculosis treated by debridement, anterior fusion, and combined posterior instrumentation surgery were analyzed. Seven patients had tuberculosis in both anterior and posterior spinal elements. There were no cases of persistence or recurrence of infection after surgery, and instrumentation provided immediate stability and protected against development of kyphotic deformity. The adherence properties of Mycobacterium tuberculosis to stainless steel (SUS 316) was evaluated experimentally. The results showed that posterior instrumentation surgery was not a hazard to spinal tuberculosis infection when combined with radical debridement and intensive anti-tuberculosis chemotherapy.