Have a history of TB disease or exposure. Be from a pastoral area and have a practice of eating raw beef and lamb. Clinical symptoms of tuberculosis toxicity. Often feel sore and sleepy in the back, occasionally feel low fever and night sweats, and the body is not wasted. Neurological symptoms appear depending on the lesion segment. Radiographs There are no obvious abnormalities in the early stage, but there are changes in physiological curvature. Compressive changes in the vertebral body. Typically, there is destruction of two or more vertebral bodies, mainly in the form of fragmentation of the anterior bones. The corresponding vertebral space becomes narrow or disappears. Paravertebral soft tissue swelling or abscess formation. CT: Mostly erosive, dissolving changes, which may be accompanied by hyperplasia, sclerosis or dead bone, and paravertebral abscesses. The vertebral arch is normal, and the accuracy of CT showing vertebral destruction is 100%. This is of great value for the thoroughness of lesion removal and prevention of recurrence of postoperative tuberculosis. Magnetic resonance imaging (MRI) has significant advantages in the early diagnosis of spinal tuberculosis, with MRI showing vertebral signal changes about six months prior to the detection of vertebral destruction on plain radiographs in more than 50% of cases. According to Guangplin Zhang [5], MRI can clearly show signal changes in the affected spinal cord and soft tissues of the pars compacta after 3 months of clinical symptoms and no abnormalities on x-ray or CT scans of early lesions. If the vertebral body is destroyed to produce a spinal cord deformity, the compression of the dural sac and spinal cord by the affected vertebral body can be shown. Multiplanar imaging of MRI is useful for observing subtle pathological changes in the spine and intervertebral disc and the extent of the lesion, especially in the sagittal position, which is useful for observing the upper and lower extent of the lesion and its invasion into the spinal canal. Multiparametric imaging is also useful for the differential diagnosis of spinal lesions. For atypical spinal tuberculosis, MRI can provide a qualitative diagnosis and a more reliable differentiation from vertebral metastases. Typical MRI manifestations of spinal tuberculosis: (1) Vertebral body manifestations: tuberculosis occurring in the vertebral body often leads to vertebral bone destruction and bone marrow inflammatory edema, with the normal high signal of bone marrow tissue in T1WI reduced and replaced by the low signal of the lesion, and enhanced signal in T2WI due to the increased water content of the lesioned vertebral body. In case of caseous abscesses, there is a homogeneous structureless long T2 signal with irregular morphology and well-defined borders, which is one of the typical manifestations of spinal tuberculosis. The endplates of the vertebral body are often involved, and disruption or even disappearance of the endplates is also a typical manifestation of spinal tuberculosis. The destruction of the vertebral body mostly occurs in the anterior part of the vertebral body, which can cause vertebral body rupture and compression fracture in serious cases. (2) Paravertebral abscess: Cold abscesses in spinal tuberculosis vary in size, show long T1 and long T2 structureless signals, and generally have clear borders. Typical cold abscesses are foveated and show ring-like enhancement with clearer borders after enhancement. Cold abscesses span one or more intervertebral spaces above and below the cold abscess and are more extensive than the lesioned vertebral body. The paravertebral and subligamentous cold abscesses erode the vertebral body causing bony destruction of the vertebral body with uneven margins. (3) Disc changes: narrowing of the intervertebral space is one of the typical manifestations of spinal tuberculosis and is an important point of differentiation from vertebral tumors. (4) Involvement of the spinal canal: When a posterior vertebral abscess is formed, it shows a long T1 and long T2 signal shadow above and below the level of the lesioned vertebral body, compressing from the epidural to the spinal canal, compressing the dural sac and spinal cord and producing deformation and displacement. In posterior vertebral abscess, the enhancement scan shows circumferential enhancement with spinal cord compression and no change in intramedullary signal. Ultrasound examination of paravertebral or psoas major abscesses in spinal tuberculosis is informative in determining surgical indications and selecting incisions and procedures. CT-guided spinal tap biopsy The use of CT scan-guided spinal tap biopsy is a safe and reliable method with a high positive rate. CT scan-guided spinal tap biopsy should be advocated for the diagnosis of difficult cases of spinal tuberculosis.