Spinal tuberculosis is one of the most common extrapulmonary tuberculosis, mainly secondary to tuberculosis of the lungs, but also secondary to tuberculosis of the urinary system and tuberculosis of the gastrointestinal system, and its incidence accounts for about 50% of all osteoarticular tuberculosis. Paraplegia is one of the most serious complications of spinal tuberculosis, the incidence of which is 10-20% in developed countries and up to 20-41% in less developed countries. Spinal tuberculosis combined with paraplegia is often slow progress, long course of the disease, poor nutritional status of the patient’s body, paraplegia after prolonged bed rest is more likely to have serious complications, seriously affecting the physical and mental health of the patient, and bringing great harm to the family and society. First, the diagnosis of spinal tuberculosis combined paraplegia Spinal tuberculosis combined paraplegia refers to the spinal tuberculosis lesion tissue or its caused by structural changes, squeezing or affecting the spinal cord caused by the spinal cord function changes and a series of symptoms, common in the tuberculosis lesions involving lumbar vertebrae 1 or more vertebrae to the thoracic vertebrae paraplegia occurs the most common, the cervical vertebrae occurred in quadriplegic paralysis; lumbar vertebrae 2 below the spinal canal diameter is wide, and the contents of the cauda equina, so the Lumbar spine tuberculosis with cauda equina compression is rare. Spinal tuberculosis paraplegia is recognized as early-onset and late-onset, active spinal tuberculosis and cured spinal tuberculosis, and it is generally believed that late-onset and cured spinal tuberculosis paraplegia are more difficult to treat and have poorer prognosis. Spinal tuberculosis combined with paraplegia has a slow progression, a long history and incomplete paralysis, which is not difficult to diagnose, but the key lies in early detection. In the early stage of paraplegia, general symptoms of tuberculosis such as fever, night sweats, fatigue, and emaciation are often manifested, and when the lesion causes spinal cord compression, it is manifested as fasciculation, limb movement disorder (loss of muscle strength and unsteady gait), sensory disorder, and sphincter dysfunction, etc. In the early stage of paraplegia, the patient may experience the usual symptoms of tuberculosis such as fever, night sweats, fatigue, and emaciation. Imaging examination plays an important role in the diagnosis and treatment of spinal tuberculosis combined with paraplegia. CT three-dimensional reconstruction image can clearly show the compression of the dural sac by proliferative bone ridge and dead bone; MRI examination can clearly define the location, scope and degree of spinal cord compression, as well as the signal of intramedullary edema and degeneration, which not only enables us to have a general assessment of spinal cord function, but also guides the scope of spinal cord decompression in the operation. Treatment of spinal tuberculosis combined with paraplegia 1. Anti-tuberculosis drug treatment The treatment of spinal tuberculosis in China is mostly carried out in general hospitals, which are unable to carry out culture of Mycobacterium tuberculosis and drug susceptibility test (referred to as “drug susceptibility test”) due to biosafety reasons, coupled with the fact that some doctors do not pay much attention to drug resistance test of Mycobacterium tuberculosis, and the chemotherapy program mostly adopts “drug resistance test”. In addition, some doctors do not pay much attention to the drug-resistant detection of Mycobacterium tuberculosis, and most chemotherapy regimens adopt a “standardized” and “one-size-fits-all” treatment plan, which will definitely lead to treatment failure when encountering drug-resistant spinal tuberculosis, especially multi-drug-resistant and extensively drug-resistant spinal tuberculosis. China is a high incidence of drug-resistant tuberculosis, the author believes that once spinal tuberculosis is clinically diagnosed, drug treatment should be started in strict accordance with the principles of tuberculosis chemotherapy, and at the same time, Mycobacterium tuberculosis drug resistance testing should be carried out as soon as possible, so as to ultimately obtain a reasonable and effective treatment plan and reduce the recurrence and retreatment rate of spinal tuberculosis. With the advances in biomolecular and genetics, such as XpertMtb/RIF and Hain drug resistance gene probe detection new technology of high sensitivity and specificity, make rapid diagnosis of tuberculosis and drug resistance detection possible. In addition, the recent debate about how long preoperative anti-tuberculosis treatment should be given has not been resolved with certainty due to the lack of multicenter, large-sample evidence of evidence-based medicine. However, the author precisely believes that this indicates that there is still much room for collaborative research. In conclusion, anti-tuberculosis drug treatment is the cornerstone of spinal tuberculosis cure and the key to ensure the success of surgery, and trivializing anti-tuberculosis drug treatment is the main root cause of recurrence and affecting the therapeutic effect. Surgical treatment of spinal tuberculosis combined with paraplegia The choice of conservative treatment or surgical treatment is still controversial and lacks an authoritative treatment guideline. In recent years, the domestic choice of surgical treatment on the basis of anti-tuberculosis drug treatment. 1990s, the UK Medical Research Council (the MRC) conducted a study on the combination of anti-tuberculosis drugs with surgical treatment and the treatment of spinal tuberculosis with anti-tuberculosis drugs alone, and found that there were differences in the angle of kyphosis, recovery of paralysis, bone fusion, cure rate, mortality rate and so on. fusion, cure rate and mortality rate, etc. The difference was not statistically significant. However, surgical treatment still has certain advantages: it can reduce the kyphosis deformity, obtain spinal cord decompression immediately, relieve pain quickly, have a higher rate of bone fusion, have a shorter time of bone fusion, reduce the recurrence rate, and have less bone loss, etc. In addition, when the bones are not yet fused, it can prevent the occurrence of delayed paralysis. Surgical access for spinal tuberculosis combined with paraplegia For patients with spinal tuberculosis combined with paraplegia, on the basis of anti-tuberculosis medication, correct access and reasonable decompression are necessary and essential, in principle, simple anterior and posterior approach can be solved basically, and some of them can be solved by combined anterior and posterior approach. Therefore, the surgical treatment of spinal tuberculosis combined with paraplegia has high requirements for the surgeon, who needs to be skillful in multiple surgical approaches, so as to choose a more appropriate surgical method for patients with a clear diagnosis. Although some surgeons may achieve the goal according to their own familiar approaches, sometimes they only focus on a certain aspect of their own concern and lack of comprehensive analysis and consideration, which may result in the recurrence of spinal tuberculosis or increased trauma. Prognosis of spinal tuberculosis combined with paraplegia Most of the patients with spinal tuberculosis combined with paraplegia can get a better prognosis through reasonable treatment, but the age, degree of paralysis, segment of the lesion, duration of the disease, type of paralysis, perioperative treatment and other factors may affect the prognosis of paraplegia.