1.Chemotherapy: The development of chemotherapy regimen for multidrug-resistant crestal tuberculosis is, in principle, based on drug sensitivity tests and history of previous drug use, with individualization as the mainstay, and attention to monitoring treatment effects, while the treatment course is extended to 24 months, with an intensive period of at least 6 months. Based on the drug sensitivity test, other first-line drugs that have not yet developed resistance are selected, and injectable drugs such as levofloxacin or amikacin are added to form a chemotherapy regimen containing at least four effective drugs during the intensive period and at least two to three effective drugs during the consolidation period. After the chemotherapy regimen is determined, care should be taken to ensure that the regimen can be implemented as required, so patients should be included in the MDR control strategy (DOTS-Plus) and direct face-to-face supervised treatment by medical staff (DOTS) as much as possible. Hospitalization during intravenous drug administration is advisable to facilitate supervision, observation and management of adverse drug reactions. 2.Surgical treatment: The traditional indications for surgical treatment of crestal tuberculosis are: (1) large cold abscesses, long-standing sinus tracts, large dead bones, large cavities, especially cavity wall sclerosis; (2) compression of crestal medulla or cauda equina or nerve roots; (3) crestal deformity and instability. Surgery allows direct removal of the invaded lesion to reduce the in vivo dissemination of tuberculosis bacteria and achieve a cure for tuberculosis. This is particularly significant in patients with multidrug-resistant crural tuberculosis. In addition, internal fixation and fusion with bone grafting techniques can rebuild the stability of the crest and improve the deformity, which can help control the lesion. However, in multidrug-resistant crural tuberculosis, internal fixation should be placed avoiding the lesion as much as possible may be a safer option. The choice of internal fixation segment should be based on the extent of the diseased vertebral body and the degree of kyphosis deformity. For patients with huge defects, titanium mesh filled with autologous bone can be chosen. However, there is still a lack of unified quantitative standard for the selection of internal fixation and bone grafting. 3, the choice of the timing of surgery: The primary choice of the timing of surgery is the timing of anti-tuberculosis drug treatment. For patients with indications for surgery, early and regular anti-tuberculosis treatment, observation of the onset and duration of drug therapy and the time to obtain control of tuberculosis are of great importance to the success or failure of surgery. In the case of drug-resistant tuberculosis, additional second-line or drug-resistant regimens are required, but there is no definitive answer as to how long it takes for drugs to take effect and be effective, and the timing of surgery needs to be determined based on the patient’s general condition and laboratory tests. In our opinion, under the premise of anti-tuberculosis drug treatment, temperature control (below 38℃) is a key indication for the timing of surgery; in addition, pain relief can be considered an important indication for effective control of tuberculosis. A normal erythrocyte sedimentation rate is not an indication for the timing of surgery, but a sustained decrease in erythrocyte sedimentation rate through anti-tuberculosis treatment indicates that the tuberculosis bacilli are under control and the local lesions will not develop further rapidly, and surgical intervention can be chosen at this time. The timing of surgery is very important for the recovery of paraplegia, especially in cases of combined paraplegia, so early surgery under effective tuberculosis drug control is the key to recovery of paraplegia. However, if we pursue the premature recovery of cremaster nerve function, it will cause the recurrence or spread of tuberculosis, which is not worth the loss. Therefore, for patients with acute cremasteric tuberculosis, early surgery can be appropriate, but only if 1-2 additional chemotherapy regimens of five to six chemotherapy regimens are administered on top of conventional chemotherapy for at least 1-2 weeks to ensure the successful implementation of surgery. For patients with multidrug-resistant crestal tuberculosis, the combination of tuberculosis elsewhere or other disorders, such as weakness, rapid decline in body mass after bed rest, and poor surgical tolerance, the rapid control of tuberculosis elsewhere and improvement of body mass before surgery are also necessary factors affecting the success or failure of surgery. For the orthopedic department of a general hospital, the diagnosis of tuberculosis of the crest should be accompanied by a careful assessment of the lung, whether it is combined with pulmonary tuberculosis, whether it is infectious, and whether it is combined with tuberculosis of other sites, especially whether it is combined with tuberculous cerebral cremasteritis, all of which need to be evaluated in order not to have unexpected consequences after surgery.