Tuberculosis of the spine is an ancient disease, with 5,000-year-old mummies found in Egyptian pyramids of people who had the disease. The treatment of spinal tuberculosis has also evolved over a long period of time. Before the invention of anti-tuberculosis drugs, doctors relied on four main measures to treat tuberculosis: good nutrition, fresh air, sunshine and plenty of rest. With the successive discovery of anti-tuberculosis drugs and the development of surgical techniques the treatment of spinal tuberculosis has changed dramatically. It is worthwhile for clinicians to carefully consider what treatment should be given to each specific patient. (A) Non-surgical treatment of spinal tuberculosis Tuberculosis is a systemic disease, and spinal tuberculosis is a localized manifestation of systemic infection of the tubercle bacillus, so only the dominant lesions can be detected by the physician, while the patient’s body is likely to have hidden lesions that go undetected. Obviously, complete surgical removal of the lesion alone does not achieve complete eradication of the lesion in the true sense. Non-surgical treatment is a holistic treatment plan for the whole body, and chemotherapy for tuberculosis in particular has revolutionized the treatment of spinal tuberculosis. Since 1943, when the first anti-tuberculosis drug streptomycin was introduced, scholars at home and abroad have always advocated the view that chemotherapy should be the mainstay of its treatment. At present, there are more than ten anti-tuberculosis drugs widely used in clinical practice, and various chemotherapy regimens have been developed based on the different stages of disease and the distribution characteristics of anti-tuberculosis drugs, such as standard chemotherapy, short-course chemotherapy, and multi-drug-resistant Mycobacterium tuberculosis chemotherapy. All regimens are based on the principles of “early, combined, complete, regular and appropriate”. Other non-surgical treatments include spinal brace therapy, Chinese herbal medicine, and psychotherapy, all of which are used as part of the overall treatment of spinal tuberculosis. (B) Surgical treatment of spinal tuberculosis The purpose of treatment of spinal tuberculosis is not only to cure the lesion, but also to stabilize the spine, correct deformities, and relieve spinal cord compression. Obviously, surgical treatment is more valuable in this regard. The surgical treatment of spinal tuberculosis has evolved through four stages: simple posterior graft fusion, simple anterior or posterior lesion removal, the Hodgson procedure for anterior lesion removal and graft fusion, and anterior or posterior lesion removal with one-stage anterior or posterior graft fusion for internal fixation. Traditionally, it was thought that internal fixation could not be placed in infected lesions, and that the presence of a foreign body fixation in an infected lesion could easily loosen the infection and make it uncontrollable or even spread. The placement of internal fixation in tuberculosis lesions has long been considered contraindicated. It has been found that Mycobacterium tuberculosis adhering to metal surfaces, unlike other bacteria, does not affect the bactericidal effect of anti-tuberculosis drugs and the immune response of the body to Mycobacterium tuberculosis. Concerns about the placement of internal fixation in TB lesions have been relieved. Studies have analyzed the adherence and infection rates of M. tuberculosis and S. aureus in culture media and in experimental dogs to titanium alloy plates, and both found that M. aureus had stronger adherence and higher infection rates than M. tuberculosis. The basic study of infected lesion inserts has contributed to the rapid development of anterior lesion removal and internal fixation for spinal tuberculosis in one stage. (C) Minimally invasive treatment of spinal tuberculosis The application and development of minimally invasive techniques in spinal surgery has brought newer treatment tools for spinal tuberculosis. Minimally invasive techniques can reduce tissue trauma and disturbance of systemic physiology to varying degrees. Currently, minimally invasive techniques in the treatment of spinal tuberculosis include thoracic and laparoscopic-assisted lesion removal, percutaneous vertebral tuberculosis lesion irrigation and drainage, and minimally invasive instrumentation for spinal tuberculosis lesion removal. Removal of vertebral tuberculosis of the lumbar 1-sacral 1 and abscesses of the psoas major muscle can be achieved via a laparoscopic approach or an extraperitoneal approach. Thoracoscopic surgery (video-assisted thoracoscopicsurgery, VATS) can be performed for the removal of vertebral tuberculosis and paravertebral abscesses in the thoracic 2-12 vertebral bodies. Percutaneous irrigation and drainage of vertebral tuberculosis lesions is a treatment that has been gradually introduced in the past decade in China and abroad. Special surgical instruments designed for minimally invasive surgery are also gradually being used for the removal of spinal tuberculosis lesions. As a trend in the development of surgery, the development of minimally invasive treatment in the field of spinal tuberculosis is also gaining attention. However, it is also worth noting that minimally invasive treatment of spinal tuberculosis is highly instrument-dependent, and there are still limitations in performing such procedures in primary care hospitals in China.