Internal fixation surgery (either anterior or posterior) is now performed in many patients with spinal tuberculosis and plays a very important role in stabilizing the spine, restoring normal vertebral height, and correcting posterior spinal protrusion! One of the reasons is that spinal tuberculosis is a specific infectious disease, sometimes caused by drug-resistant Mycobacterium tuberculosis and sometimes by non-tuberculous mycobacteria (NTM), and therefore it is a disease that requires medical treatment in the first place! If internal treatment is effective, patients can be cured without surgical treatment at all. If spinal tuberculosis is combined with paraplegia or neurological dysfunction, or if there are large abscesses or dead bones, spinal tuberculosis lesion removal can be considered, and postoperative anti-tuberculosis treatment can be continued for at least 1 year, along with bed rest and nutrition. Many patients with paralysis can also recover. From the point of view of tuberculosis, internal fixation, such as titanium mesh and steel plate, is generally not recommended in the lesion, and even bone grafting in the severe defect area is controversial because focal debridement is theoretically impossible to remove completely, and mycobacterium tuberculosis must remain in the lesion. At this time, the plate or titanium mesh in the lesion becomes a “foreign body” and “source of infection”, causing long-term chronic infection and delayed healing of the incision! Removal is difficult and the lesion does not heal without removal, putting the patient and the surgeon in a dilemma! Therefore, if internal fixation surgery is really needed, these “foreign bodies” should be as far away from the lesion as possible, and farther! What if there is recurrence, abscess formation and incision non-healing after internal fixation? We recommend the following: 1. If possible, culture, drug sensitivity and strain identification of Mycobacterium tuberculosis in the pus to clarify whether the spinal lesion is a Mycobacterium tuberculosis infection? Or is it drug-resistant? These tests can only be done at a hospital specializing in tuberculosis or an infectious disease hospital. 2. If Mycobacterium tuberculosis cannot be found or there are no local conditions for these tests, the treatment plan can be adjusted after consultation with a tuberculosis surgeon or internist. 3.If the abscess is large and the incision does not heal, we should consider removing the “foreign body” from the lesion and clearing the lesion again; if there is no foreign body such as “steel plate” or “titanium mesh” in the lesion. However, it is worth noting that the removal of the lesion itself can cause medical instability of the spine and posterior spinal deformity, which can easily fracture the posterior nail bar system. Regarding the criteria for cure of tuberculosis, there is a good saying that “tuberculosis is not cured if it does not heal deformed”, whether it is spinal tuberculosis or joint tuberculosis, only when it reaches bony ankylosis is it considered cured. Fibrous fusion also meets the criteria for healing, but there is a possibility of recurrence. In patients who can achieve fibrous fusion, the preoperative damage to the spine is mild and most do not require internal fixation, while patients with severe spinal damage can be cured only if they achieve bony fusion, which is based on complete lesion removal, not internal fixation. After osseous ankylosis of the spine, stability is better, as in a single stage, without affecting its active function. In conclusion, it is difficult to choose any type of procedure that will allow complete lesion removal while maintaining joint mobility, and probably only early antituberculous treatment with timely and appropriate surgical lesion removal can satisfy this condition!