We present a case of a 68-year-old female with an atypical form of spinal tuberculosis, which involved posterior elements with multiple foci in two noncontiguous vertebral levels. The lesions caused spastic paraparesis and urinary hesitation. There was no evidence of pulmonary or other extrapulmonary tuberculous disease. Based on clinical and radiographic findings, this atypical spinal tuberculosis was preoperatively misdiagnosed as metastatic spine tumor. The histopathologic finding confirmed tuberculosis and the patient was treated successfully with surgery and antituberculous therapy. In case of a spinal lesion of unknown origin, it is important to be aware that atypical spinal tuberculosis can mimic metastatic spine tumor and tuberculosis should always be considered.