Patients with thoracolumbar spine tuberculosis often have two or more abscesses at the same time, so the choice of operation should be careful. Commonly used surgical procedures are: ① renal incision extrapleural – extraperitoneal surgery, that is, the upper transverse rib resection and the lower inverted octagonal incision combined with surgery. ②Trans-thoracic – extraperitoneal surgery, that is, the upper transpleural cavity and the lower inverted octagonal incision combined. ③Transpleural-extrapleural-peritoneal operation, i.e., the combination of thoracic extrapleural and lower inverted-eight incision. In the case of paraplegia, spinal canal decompression should be performed at the same time. Wang Cheng, Department of Thoracic Surgery, Shandong Thoracic Hospital, Shandong Province, China. The renal incision extrapleural-peritoneal procedure is often chosen for those with bone lesions below T11, long paravertebral abscesses of the thoracic vertebrae, small lung capacity, and poor cardiorespiratory function. The procedure is simple and easy to perform, has little interference with the respiratory cycle, and does not contaminate the thoracic cavity. However, the pleura should not be damaged when exposing the lateral side of T12-L1 vertebrae and amputating the small head of ribs, so as to avoid pneumothorax. The key to avoid damage to the pleura is to completely cut the rib neck and costal ligament before removing the costal tuberosity, and when stripping the costal periosteum, the periosteum should be fully stripped tightly against the bony tissues, and the force should be gentle, avoiding violence and uncontrolled force. Trans-thoracic – peritoneal extra-peritoneal surgery bone lesions above T11 is mainly, paravertebral abscess is longer; the spinal canal decompression range is wider; the lesion involves the pleura or the lungs are mostly used in this surgery. The operation field is well exposed, and the lesion removal and decompression of the spinal canal are more thorough, especially when the thoracic paravertebral abscess is longer, it can avoid damaging multiple nerve roots, thus avoiding paralytic abdominal wall hernia; in addition, it can deal with lung and pleural lesions at the same time. Intrathoracic extrapleural-peritoneal operation This operation is often used when the bone lesion is mainly above T11, and the paravertebral abscess is long, and the cardiopulmonary function is poor. The advantages of this procedure are good visualization of the surgical field, small impact on cardiopulmonary function, and no contamination of the thoracic cavity. The key to success is to avoid pleural rupture when peeling the wall pleura from the extrapleural space. For the combined bilateral psoas major muscle abscess, as long as their physical condition allows, should be carried out a one-time bilateral division to remove the lesion. This can not only avoid the pus backflow to the operated side, but also reduce the pain of multiple surgeries. For those with paraplegia, decompression of the spinal canal should be performed at the same time. Although transverse rib resection is simple and easy to perform, it cannot clean up the lesion in the spinal canal under direct vision and completely relieve the compression of the spinal cord from the lesion; although lateral decompression of the spinal column is sufficient and thorough, it is more destructive to the stability of the spinal column; whereas anterolateral decompression of the spinal canal can relieve the spinal cord from the compression under direct vision without affecting the stability of the spinal column, and therefore, it has been adopted more often. It is especially important to avoid inadvertent injury to the spinal cord during the operation. The anterior curved edge of the posterior elliptical costochondral notch is the safe incision area of the thoracic vertebral body, and the anterior curved edge of the corresponding transverse process, one transverse finger in front, is the safe incision area of the lumbar vertebral body. In the process of decompression of the spinal canal, in addition to removing the pus, cheese and granulation tissue, dead bone and the bone ridge at the posterior edge of the vertebral body that oppresses the spinal cord, the epidural fibrous adhesive cords and fibrous rings of the spinal cord should also be peeled off and removed, so that the spinal cord can really be decompressed completely and the conditions for the recovery of paraplegia can be created. Bone grafting is a reliable solution for spinal stability. Bone grafting can be avoided in patients with small bone defects. For adult patients with severe bone loss, bone grafting is usually performed during surgery; if anterior bone grafting is not suitable at the same time, posterior bone grafting can be performed one month after surgery to increase spinal stability and avoid aggravation of deformity. Children should not have open-slot insertion bone grafting to avoid damage to the epiphysis and aggravation of deformity after surgery. Excerpted from the paper “Selection of surgical procedures for tuberculosis of thoracolumbar spine” written by Wang Cheng, et al. published in Shandong Medicine, vol. 39, no. 11.