The incidence of paraplegia in crestal tuberculosis is about 10%, and combined paraplegia is common in the thoracic spine, followed by the cervical, transthoracic and thoracolumbar segments, with the lumbar spine being the least common. Tuberculosis of the crestal attachments is rare, but because the vertebral arch surrounds the spinal canal from three sides, there is a higher rate of combined paraplegia when it occurs. The causes of paraplegia complicated by tuberculosis of the crest are mostly due to direct compression of the crestal medulla by tuberculous abscesses, dry lo-like necrotic material, tuberculous granulation tissue, dead bone, and necrotic intervertebral discs in the early or active phase of the disease, which is called osteopathic active paraplegia. The results of timely surgical decompression are good. In the late stage or healing stage, the thickened dura, granulation tissue fibrosis and fibrous tissue proliferation in the spinal canal form an annular compression on the crestal medulla, or the destruction of the vertebral body causes the deformation of the crestal kyphosis, or the bone redundancy in front of the spinal canal caused by the pathological dislocation of the vertebral body makes the crestal medulla suffer from compression or wear and tear and leads to fibrous degeneration, causing paraplegia, which is called osteopathic static paraplegia. In addition, embolism of the crestal vessels leads to degeneration and softening of the crestal medulla, and paraplegia can also occur in this case, although there is no external compression. In addition to the systemic symptoms and local manifestations of tuberculosis of the crest, there are also clinical manifestations of compression of the crestal medulla. The initial manifestation is back pain and a sensation of tethering of the lesioned segment, followed by paraplegia. Motor dysfunction usually occurs first. Due to the slow development of the tuberculosis lesion, the crestal medulla is slowly compressed, which gradually leads to crestal medullary conduction dysfunction, while the crestal lumbar expansion is not damaged and the reflex arc is still intact, so the clinical manifestation is spastic paralysis. If the process of nodular lesion is fast, pathological fracture or retroconvex deformity of vertebral body is formed within a short period of time, coupled with the rapid increase of dry lo-like necrotic material, etc., the crestal medulla is acutely compressed, and the reflex arc of the lumbar expansion temporarily loses its function due to the influence of overt containment, thus manifesting as flaccid paralysis in the early stage and turning into spastic paralysis after the influence of containment disappears. CT and MRI examinations can clearly show the crural medullary compression at the site of the lesion, and MRI can observe the change of crural medullary signal, which can help to judge the prognosis. Treatment In principle, all patients should receive surgical treatment. In some elderly people, or in cases where the general condition is too poor to tolerate surgery, non-surgical treatment can be given first, and surgery can be performed after the general condition improves.