Because the clinical manifestations of spinal tuberculosis and spinal tumors have many similarities and overlapping imaging manifestations, and the treatment methods are very different, mistaking tuberculosis for tumor treatment can cause serious adverse consequences for patients, so clinical differentiation is often necessary. We appreciate that the differentiation should be made from the following aspects: 1. whether there is a history of tuberculosis. 2. 2. the nature of the pain. 3, the length of the history. 4.Imaging performance. 5.Bacterial culture. 6. pathological histological examination. The first three are often the common manifestations of the two diseases, the differentiation is for reference only, the last three are often specific, especially the last two have diagnostic value. In addition, it should be combined with other auxiliary examinations for comprehensive analysis. In clinical work, we often encounter patients with X-ray, CT, MRI films looking for doctors to give a look, hoping to make a diagnosis. Even if the imaging is very tumor-prone, the clinical diagnosis is often made first as a suspicion. Spinal tuberculosis occurs in the thoracolumbar, lumbosacral, and cervical spine, and lesions often occur in the intervertebral space, with a few lesions occurring in the central part of the vertebral body. The imaging manifestations are characterized by narrowing of the intervertebral space, bone destruction in the adjacent vertebral body, abscesses, dead bone, and sinus tracts in some patients, and bone destruction characterized by worm-like erosion and sclerosis of the surrounding bone. Most lesions occur in the vertebral body and a few accumulate in the adnexa. Most common clinical vertebral tumors are metastatic carcinomas, and primary vertebral tumors include vertebral lymphoma, giant cell tumor of bone, neurofibroma, eosinophilic granuloma, multiple myeloma, and Langerhans cell tumor. The final diagnosis often relies on pathology reports. However, the possibility of vertebral tumor should be considered clinically if the following imaging manifestations are present: 1. Osteolytic destruction of vertebral body. 2.Osteolytic destruction of accumulated attachments. 3, flattened vertebrae. 4.Multi-segmental vertebral destruction.