The incidence of spinal tuberculosis in the elderly is also on the rise, as our population is aging. Older patients have poorer immune function and are often associated with cardiovascular, respiratory, and digestive diseases, making surgical treatment riskier. Prior to the use of internal fixation surgery in the treatment of spinal tuberculosis, simple focal debridement was the main procedure for the treatment of spinal tuberculosis, requiring patients to be bedridden for long periods of time after surgery. The complications of prolonged bed rest in elderly patients are many and the mortality rate is high, so in the past, conservative treatment was mostly used for elderly patients with spinal tuberculosis. However, for those with severe vertebral destruction or severe pain, conservative treatment also requires bed rest, which can also produce complications of prolonged bed rest. Therefore, the key to treating elderly patients with spinal tuberculosis is to reduce the complications associated with prolonged bed rest by getting them out of bed early. With the widespread use of internal spinal fixation devices, early postoperative bed mobility has become possible in elderly patients, and more and more scholars advocate the use of surgery for the treatment of spinal tuberculosis in the elderly. However, with the development of internal fixation surgery, the problems of poor surgical tolerance and postoperative complications in elderly patients are highlighted, and elderly patients are often associated with osteoporosis and have a higher rate of postoperative internal fixation loosening. Xue Binhai et al. treated 36 cases of elderly spinal tuberculosis using different surgical approaches, 28 cases had preoperative comorbidities and 33 postoperative complications occurred in 33 cases. Therefore, for the clinical characteristics of elderly patients, the selection of an individualized procedure suitable for elderly patients is the key to treatment. Zhang et al. compared the effect of simple posterior approach and combined anterior-posterior approach in the treatment of thoracic spinal tuberculosis in elderly patients, and the results showed that simple posterior approach with lesion removal and internal fixation and bone graft fusion was more effective. They concluded that the simple posterior approach is suitable for elderly patients with poor physical fitness, early lesions, and mild to moderate kyphosis. The incidence of lumbar spine tuberculosis is the highest, with double vertebral tuberculosis being the most common. The difference between the VAS scores at 7 days after surgery and at the last follow-up was statistically significant (p<0.01). 5 patients with symptoms of spinal cord compression improved their neurological function by at least one level on the Frankel scale (Table 1). Postoperative radiographs showed partial correction of the segmental kyphosis in all patients, with a correction angle loss of 9.5°±3.6° (p<0.01); the correction angle loss at the last follow-up was 7.2°±2.3°, with a statistically significant difference compared with the postoperative period (p<0.01). There were 30 postoperative complications: 5 cases of pulmonary infection, including 1 death, 5 cases of cardiac insufficiency, 2 cases of cerebral infarction, 2 cases of loosening of internal fixation, 5 cases of sinus tract formation, 5 cases of drug-related liver damage, 6 cases of drug-related rash, and all other patients safely passed the perioperative period. 1 83-year-old patient with lumbar spinal tuberculosis fused with a simple posterior fixation interlaminar graft had increased symptoms of lumbar 3 nerve root compression 3 months after surgery. Two cases of loose internal fixation, one with thoracic 11 and 12 tuberculosis, were found to have loose internal fixation and mild displacement of the titanium cage 3 months after surgery, with only a 3° increase in the posterior convexity angle until 1.5 years after surgery, and the patient had no discomfort and refused to remove the internal fixation, which is still under follow-up; the other case had loose arch nail after posterior lesion removal for lumbar tuberculosis, and the bone healed after prolonged brace fixation. Five cases of sinus tract formation had sinus tract closure after 1 to 3 months of local drug exchange. 5 cases of drug-related liver damage and 6 cases of drug-related rash had drug reactions and rash gradually disappeared after drug adjustment.