Anterior and paravertebral soft tissue swelling or abscesses are one of the important features in the diagnosis and differential diagnosis of spinal tuberculosis, and in particular, calcification of abscesses is often specific. Anterior paravertebral soft tissue swelling or abscesses are commonly seen in cases of spinal tuberculosis with extensive and severe destruction of the vertebral body and adnexa. Spinal radiographs can observe changes in the vertebral body, intervertebral discs, surrounding soft tissues, and signs of destruction of the vertebral arch. It is important for clinical diagnosis and differential diagnosis, but its resolution, revelation of the extent of the lesion, and whether the spinal canal is involved have major limitations. It is not easy to detect early lesions. CT scan has unique advantages in the identification of the type of destruction of the vertebral body, the presence or absence of swelling or abscess in the paravertebral soft tissue, the presence or absence of dead bone masses, the presence or absence of compression of the dural sac, etc. It can promptly detect minor destruction of the anterior part of the vertebral body and potential defects at the anterior edge that are difficult to detect by conventional X-ray plain examination, show the degree of destruction of the diseased vertebra and the relationship with the surrounding tissues, and display the pathological changes of the vertebral body more clearly, which is important for guiding clinical It is important for guiding clinical treatment. However, because it is a cross-sectional scan, lesions in asymptomatic segments are easily missed. MRI is more advantageous than CT in showing the destruction of the intervertebral disc, spinal cord and dural sac invasion, especially it is more sensitive to the destruction of the intervertebral disc or adjacent disc bone destruction, which can provide an important basis for early diagnosis, therefore we should apply the imaging detection means reasonably. In addition, the tuberculin test (PPD) is a common clinical indicator of TB infection in pediatric patients, but a positive PPD only indicates a history of TB infection, not necessarily a current disease, i.e., a positive PPD does not confirm a diagnosis of TB disease, and a negative PPD does not negate TB disease either. Blood sedimentation is a common indicator of tuberculosis activity, not a characteristic marker, and cannot be used as a basis for diagnosis of spinal tuberculosis. However, regular and repeated blood sedimentation tests can help to infer the development of tuberculosis and the effect of treatment, and are of reference significance in the selection of the timing of spinal tuberculosis surgery. Pathological biopsy is an important tool in the current increase in clinical atypical spinal tuberculosis. Surgical incisional biopsy is more invasive and increases the economic burden on patients; percutaneous puncture biopsy is an effective diagnostic technique, and biopsy can be performed first for cases that are difficult to diagnose clinically or by imaging. With the development of new culture systems and molecular strain identification technology, it is possible to culture and identify Mycobacterium tuberculosis, but not many laboratories in China are equipped to perform this test. In conclusion, the clinician’s diagnosis of spinal tuberculosis should be made by combining the patient’s medical history, symptoms, signs, imaging and laboratory tests to make a correct diagnosis.