Spinal tuberculosis is one of the more common forms of extrapulmonary tuberculosis and is caused by the invasion of the vertebral body by Mycobacterium tuberculosis, resulting in destruction of the vertebral body and the formation of paravertebral abscesses and, in severe cases, paralysis. Clinical manifestations include pain, weakness, localized masses, with or without hypothermia, night sweats, and in some patients, other symptoms such as cough and sputum. The imaging manifestations are destruction of the vertebral body, narrowing of the intervertebral space, paravertebral cold abscesses, and in some cases, compression of the spinal canal. Prior to the mid-20th century, patients with spinal tuberculosis were mainly treated with medication, supplemented by braking and rest, and surgery was mainly performed to drain abscesses in patients with abscesses; in 1954, Hong Kong physicians Hodgson and Stock first reported the performance of anterior radical lesion removal and autologous bone graft fusion in patients with spinal tuberculosis, also known as the Hong Kong procedure, which is based on anterior lesion removal. In the 1960s, Professor Fang Xianzhi, a senior orthopedic surgeon in China, performed this procedure and it was widely carried out in China to improve the cure rate of spinal tuberculosis. With the extensive use of new materials and technologies in spinal surgery, intervertebral bone grafting with internal fixation for the removal of spinal tuberculosis lesions was gradually carried out in the clinic, which can effectively restore spinal stability, prevent kyphosis and promote bone graft fusion with great advantages, and has become the main surgical modality for the treatment of spinal tuberculosis. With the use of minimally invasive techniques in clinical practice, minimally invasive surgery for spinal tuberculosis is gradually being performed, but this type of surgery is not applicable to all patients and therefore has some limitations. The history of spinal tuberculosis surgery is actually a microcosm of the history of spinal surgery, and with the development of technology the surgical treatment of spinal tuberculosis will become more and more perfect, bringing greater benefits to the majority of patients.