Patients with AIDS, dialysis, the elderly and frail, hepatitis and malignancy are prone to spinal tuberculosis. This is a 33-year-old male leukemia patient who had myelodysplastic syndrome in 2014, which later turned into M2 leukemia. The patient had developed low back pain in the last 3 months, which gradually worsened and prevented him from lying flat and changing position when lying on his side. At the time of admission, he was severely anemic, had severe lumbar pain, could not lie down, could only sleep on his side, and could not turn over at will. MRI showed destruction of lumbar 2 and 3 vertebrae, narrowing of the space, abscess formation in the spinal canal, and local posterior convexity deformity. Because the patient had leukemia and poor ability to tolerate surgery, postoperative to lead to incision infection and non-healing, hematology consultation was requested and only symptomatic treatment was available. However, the patient’s hemoglobin index could only be maintained by repeated blood transfusions, and the pain was getting worse and could only be relieved by pain medication. The hematologist recommended surgery to relieve the patient’s pain and improve the patient’s life treatment, but adequate blood transfusion was needed to correct the patient’s anemia before surgery. After correcting the patient’s anemia, we performed posterior spinal tuberculosis lesion removal and internal fixation with intervertebral bone graft fusion, and the procedure went smoothly. Intraoperatively, we were surprised to find that the lumbar disc of the diseased segment was completely detached and free, and was removed intact intraoperatively, with the nucleus pulposus and fibrous ring intact except for a small amount of nucleus pulposus tissue remaining in the center. It was reasoned that the patient could not lie flat and could only lie on his side on a daily basis because of the exfoliation of the disc, which led to severe instability of the patient’s vertebrae and severe pain caused by slight movement of the lumbar region. The extremely poor resistance of patients with leukemia may be the reason why the intervertebral disc tissue is prone to complete detachment, but further studies are needed. The surgical experience in this case also suggests that patients with spinal tuberculosis combined with leukemia have a greater need for surgical treatment to remove the detached discs and stabilize the spine because the discs are easily destroyed and detached leading to spinal instability. Despite the poor ability of patients with leukemia to tolerate surgery, surgical healing is still good as long as preoperative evaluation is done carefully to correct comorbidities such as anemia and malnutrition. Most of them were heavy