Spinal tuberculosis accounts for about half of all osteoarticular tuberculosis, with the most occurring in adolescents and children. All vertebrae can be involved, but the lumbar spine is the most common, followed by the thoracic spine, and less frequently the cervical spine, which occurs in the thoracic 12 and lumbar 1 vertebrae, thoracic 1, 2 and 3 vertebrae, lumbar 3 and 4 vertebrae, and lumbar 5 and sacral 1 vertebrae with a large range of motion and weight-bearing damage. First, the pathology of spinal tuberculosis lesions occur mostly in the vertebral body, a few in the vertebral plate, arch, spinous process and transverse process. 1, central or juvenile type: pediatric vertebral body around the cartilage component, the central ossification part of the lesion development may have collapsed early vertebral space is still in. 2, marginal type: also known as epiphyseal type or adult type, occurs in older children or adults, starting from the epiphysis of the upper or lower edge of the vertebral body, lesions often rapidly destroy the intervertebral soft tissue, so that the intervertebral space narrowed or disappeared, the upper and lower vertebral body connected. 3, anterolateral type or subperiosteal type: this also occurs in adults, located under the anterior vertebral ligament, often spreading to involve the upper and lower adjacent vertebrae. Medical education network collection 4, adnexal tuberculosis: such as tuberculosis of the transverse process, vertebral plate, pedicle or spinous process, is less common. Vertebral lesions due to circulatory disorders and tuberculosis infection, there is bone destruction and necrosis, caseous changes and abscess formation, collapse of the vertebral body due to lesions and weight bearing, so that the spine forms curvature, spinal bulge, hump deformity of the back, thoracic spine tuberculosis is particularly obvious. Due to collapse of the vertebral body, dead bone, granulation tissue and abscess formation, paraplegia can occur due to compression of the spinal cord, which occurs more frequently in the cervical and thoracic spine. Bone destruction and cold abscesses form under the anterior longitudinal ligament of the spine, which may cross the ligament to the anterior fascial space of the spine and may spread to sites far from the lesion due to gravity. Cervical tuberculosis abscesses may appear in the anterior cervical spine causing bulging of the posterior pharyngeal wall, which can cause dysphagia or dyspnea; on both sides of the neck they may appear subcutaneously at the posterior border of the sternocleidomastoid muscle. Thoracic spinal tuberculosis often forms prevertebral and paravertebral abscesses, which may also develop in the posterior mediastinal region or along the intercostal space toward the chest wall; progression toward the spinal canal may cause paraplegia. Lumbar spine tuberculosis abscesses often reach the pelvis and form lumbar muscle abscesses that spread down the iliopsoas muscle to the groin or medial femur, from the posterior femur to the greater trochanter, along the broad fascial tensor and iliotibial bundle to the lower lateral femur; or spread backward to the lumbar triangle. These abscesses, because they do not show signs of acute inflammation, are called cold abscesses. In the course of improvement of spinal tuberculosis, the destructive products of the lesion, such as abscesses and dead bone, can be gradually absorbed, while there is fibrous tissue filling and repair, and finally fibrous healing and bony healing are formed, and the course of the disease is long. However, through active treatment, the course of the disease can be greatly shortened. Clinical manifestations and diagnosis 1, back (lumbar) pain and radiated pain: pain mainly in the spinal lesion site, the onset of the initial not heavy, with the development of lesions and intensify, rest can be reduced or temporarily disappear; different parts of the lesion can also cause a variety of transfer pain. The pain increases during weight-bearing, walking and spinal activities. 2, muscle spasm and movement disorders: muscle spasm, spinal activity is limited by a protective role of the body. Children’s muscle relaxation after sleep, the slightest movement of the back will cause pain, “night cry”. 3. Late stage often has back deformity and cold abscess, and the abscess often extends to the subcutaneous abscess formed by the flow of muscle gap. 4.Late paraplegia has spinal cord compression and partial or complete paraplegia. 5, MRI shows bone destruction at the edge of the vertebral body, often involving the upper and lower edges of the adjacent vertebral body, showing T1WI low intermediate signal, T2WI high signal, edema areas of varying degrees are seen around the destruction area, showing T1WI low signal, T2WI equal high signal, and narrowing of the vertebral space; CT shows: 1, speckled, speckled, cave-like or honeycomb bone destruction; 2, increased bone density of the vertebral body; 3, intervertebral disc destruction; 4. dead bone formation; 5. paravertebral abscesses, which often have foci of calcification; 6. bony spinal stenosis; 7. vertebral compression changes. Third, the treatment of spinal tuberculosis if there is vertebral bone destruction, combined with dead bone, paravertebral abscesses, and intervertebral disc destruction. Surgical treatment should be considered. (a) Preoperative preparation 1, bed, so that the lesion of the spine is not weight-bearing, is necessary to prevent the development of lesions, serious deformities and paraplegia, flat hard bed. 2, strengthen nutrition, enhance the body’s ability to resist disease. 3.Application of anti-TB and hepatoprotective drugs, intensive treatment for more than half a month to understand the presence of tuberculosis lesions in the lungs, if there are lesions in the lungs, prolong anti-TB, and consider surgery after stabilization of tuberculosis lesions in the lungs . (B) surgical methods vertebral destruction and cold abscess or large dead bone, more lesion removal, thoracic spine tuberculosis, transverse rib resection and lesion removal. If the vertebral bone destruction is heavy, bone grafting is used if necessary. Lumbar spine tuberculosis lumbar 1, 2, 3 vertebral tuberculosis is often treated by renal incision, extraperitoneal treatment of vertebral dead bone and abscesses of the lumbaris major muscle. Lumbar 3, 4, 5 and sacral 1 vertebral tuberculosis lesions are often treated with an inverted octagonal incision and extraperitoneal management of vertebral dead bone and paravertebral abscesses. (C) Postoperative management Postoperative treatment requires intensive anti-TB and hepatoprotective treatment for more than 3 weeks, flat bed for more than 3 months, absolute bed rest and bed urination and defecation. Prevent pressure sores and enhance nutrition. Exercise both upper limbs and both lower limbs in bed to prevent muscle atrophy.