Study Design: Retrospective observational study. Objectives: To evaluate the clinical outcomes of Image-guided percutaneous drainage combined with anti-tuberculous therapy in patients with spinal tuberculous abscesses. Setting: Tripoli University Hospital, Libya. Patients & Methods: We retrospectively reviewed the clinical & radiological images of 10 Libyan patients with spinal tuberculous abscess, treated with image-guided percutaneous drainage, anti-tuberculous chemotherapy (ATT) and spinal bracing. They were 8 females and 2 males with a mean age of 34 years. 3 patients (30%) presented with paraparesis. They were followed up for an average of 26.4 months. Outcomes were assessed using Visual Analog Scale (VAS) for back pain, Erythrocyte Sedimentation Rate (ESR), ASIA Impairment Scale (AIS) for neurological assessment and Cobb’s (deformity) angle measurements. Results: The mean duration of symptoms before diagnosis was 5.4 months, mean abscess volume drained was 480 ml, and median duration of ATT was 18 months. All 10 patients improved generally, ESR dropped from 108 ± 16.7 mm/hr to 15.2 ± 7.4 mm/hr (p < 0.00001). Pain VAS decreased from 7.8 ± 1.6 to 1.9 ± 1.4 (p < 0.00001). At presentation, there were three patients with paraparesis (AIS C-D); all improved to AIS E. Cobb’s angle increased from 21.9° to 27.4° with no evidence of instability. Conclusion: In conjunction with ATT, percutaneous drainage is a safe and effective intervention for spinal TB abscesses, yielding significant pain relief, neurological improvement and inflammatory control.