Tuberculosis (TB) is one of the biggest killers of human beings. In 1998, about 8 million people worldwide suffered from TB, of which 2 million died. In 2005, it was reported that 8.8 million people had the disease and 3 million died. The disease is most prevalent in developing countries, with 98% of cases occurring in poorer countries and regions, with Asia and Africa being the regions with the most patients. The rise in the incidence of AIDS today has made tuberculosis more prevalent. Bone tuberculosis accounts for about 3% of cases, half of which are in the spine. Tuberculosis in the spine is more dangerous than in other parts of the body. The destruction of the spine can lead to spinal deformities, even bilateral lower limb paralysis and pulmonary insufficiency. In children, the risk is more severe if the thoracic spine is attacked. Tuberculosis in the spine usually spreads hematologically, and often two or more vertebrae are destroyed by the attack of the tuberculosis bacillus. The anterior aspect of the vertebral body is most likely to be compressed by the pressure of the body weight, resulting in a posteriorly convex deformity of the torso. The intervertebral discs also lose their elasticity and protrude outward due to obstruction of blood flow in the vertebral body. Inflammation caused by Mycobacterium tuberculosis can result in bone destruction and the formation of abscesses that accumulate in the spine’s sides or muscles, called cold abscesses. Cold abscesses flow out of the skin through openings and form sinus tracts that are difficult to heal. I. Signs and Symptoms When tuberculosis is active, the patient’s spine appears rigid and painful when moving. The pain usually has a fixed location and is painful to palpation. The patient may have a kyphotic deformity, a cold abscess next to the spine, and neurological symptoms. Patients may show symptoms of systemic toxicity, with hypothermia (about 38 degrees), weight loss, weakness, anemia, etc. 1. Hematological examination: Blood sedimentation rate (ESR) and C-reactive protein (CRP) are elevated during the active phase. The white blood cell count may be slightly elevated. 2.X-ray: In the earliest stage, the vertebral space is usually narrowed in height with blurred edges. As the vertebral body is invaded, the vertebral body becomes wedge-shaped or even kyphotic. In severe end-stage cases, the entire vertebral body is damaged. Paravertebral abscesses can appear on both sides of the cervical or thoracolumbar spine, and soft tissue shadows can be seen on X-rays. 3.CT and MRI: It can detect the lesion and its extent at an early stage. It can also understand the degree of spinal cord compression and the size and location of cold abscesses. MRI can distinguish abscess from granuloma tissue after enhancement. Third, the differential diagnosis 1, congenital spinal defects: some hemivertebral deformities, which are present after birth in children, should be distinguished. 2, other spinal inflammatory conditions: often occur due to staphylococcal, streptococcal or gram-negative bacterial infections. Usually the clinical symptoms are more severe, their occurrence is rapid and there is severe local pain. Severe muscle spasms may occur, often accompanied by high fever. However, if hypothermia is present, other bacterial infections such as Salmonella, syphilis, and mycobacteria can be manifested as hypothermia and are often difficult to differentiate. However, tuberculous and septic spondylitis still each have their own characteristics on MRI images. 3, hemangioma or other benign or malignant tumors, metastatic cancer have similarities with it. Therefore, they should be differentiated by bacterial culture, tissue biopsy, or administration of experimental antibiotics. Biopsy can be done under CT guidance. The principles of treatment for spinal tuberculosis are adequate rest and nutrition, chemotherapy and, if necessary, surgery. Whether surgery is performed or not, a brace should be given to reduce pain and prevent worsening of kyphosis. Most patients do not require hospitalization. Patients who are hospitalized are usually (1) presenting with symptoms of nerve compression, (2) presenting with severe low back pain and muscle spasm requiring medical care, (3) presenting with kyphotic deformity of the cervical spine requiring traction, and (4) requiring surgical treatment. Because the number of tubercle bacilli in bone tuberculosis is generally small and the bacilli gather in clusters rather than spread out in planes, sometimes the bacilli are in a sleeping state. Since cell division is rather slow, anti-tuberculosis drugs can be applied intermittently with approximately the same effect as daily dosing. In early spinal tuberculosis, drug therapy can prevent the development of retroconvex deformity. Therefore, patients with mild invasion of the spine should be given aggressive drug therapy, which is expected to cure and prevent complications. The first-line antituberculosis drugs are isoniazid, rifampin, pyrazinamide, and ethambutol. To prevent the development of drug-resistant Mycobacterium tuberculosis, at least three drugs should be used in combination. In atypical TB, such as Mycobacterium avium subspecies avium infection or M. kansasii, three to four antibiotics should also be used, depending on drug resistance, of which amikacin, ofloxacin, and ciclofloxacin should be considered and combined with rifampicin, pyrazinamide, and ethambutol. The duration of administration varies from about 6 months to 24 months. V. Surgical treatment Indications for surgery are: (1) cold abscess formation; (2) moderate or severe spinal invasion damage: (3) symptoms of nerve damage, such as weakness or paralysis of the lower limbs; (4) spinal deformity. The purpose of surgery is to thoroughly debride, clarify the diagnosis, restore neurological function, and prevent or correct spinal deformities.