Most of the extra-pulmonary TB is not diagnosed by us, we are in charge of the treatment, for example, spinal TB. Many patients with spinal tuberculosis are mostly referred by orthopedic surgeons, or they may come in for pulmonary tuberculosis and find out they have spinal tuberculosis at the same time through an examination. The process of diagnosing and treating spinal tuberculosis: 1. The diagnosis of spinal tuberculosis must begin with a CT or MRI of the spine. 2. Then I will ask the orthopedic surgeon (a more detailed subspecialty is spine surgery) to consult with the patient or let the patient go to the orthopedic surgeon himself, and the orthopedic surgeon will make the differential diagnosis of whether the patient is first considered to have spinal tuberculosis. 3.If yes, then I would first treat the patient with anti-tuberculosis drugs, while paying attention to absolute bed rest. 4. It is best to review the patient’s spinal CT or MRI after 1-2 months of anti-tuberculosis treatment. 5, go to orthopedics to see if surgery is needed, if it is needed, surgery may not be needed if the spinal bone destruction is mild. 6. The anti-TB course should take 1 to 1.5 years. There are a few points that need special attention: 1. Spinal tuberculosis should be diagnosed and treated early. How can this be done? If you have back pain or lumbar pain, you should have a CT or MRI of the spine early. Other methods such as taking ordinary X-rays cannot be seen early, and by the time you can see it, the bones are already very rotten. 2, the first consideration for patients with spinal tuberculosis, unless there is an indication for emergency surgery, never first open surgery, must first anti-tuberculosis treatment. 3, anti-tuberculosis treatment of spinal tuberculosis must be strong, and it is best to use intravenous drugs, because the blood supply inside the bones is not as strong as other organs, with the blood reaching the bone lesions less anti-TB drugs, intravenous drugs can make the blood concentration higher. Generally, 4 kinds of anti-TB drugs are used for pulmonary tuberculosis, and 5-6 kinds can be used for spinal tuberculosis. 4. Absolute bed rest, even getting up to go to the toilet is forbidden because it may lead to fracture paralysis. 5, light patients can be treated with internal anti-TB treatment without surgery, but there are fewer such patients, mainly because most patients are found too late, the spinal bone destruction is too serious, or a paravertebral cold abscess is formed, so that surgery is necessary. 6. Patients with indications for emergency surgery must be operated on urgently, such as symptoms of paraplegia and urinary and fecal incontinence. However, even after surgery, there are many patients who are still paralyzed and cannot recover. I once admitted a male patient with lumbar spine tuberculosis who had back pain for a year without proper attention, and then went to the orthopedic department and suspected lumbar spine tuberculosis, so he came to our hospital, and our tuberculosis doctor told him to be hospitalized quickly. He said he didn’t have any money and didn’t want to be hospitalized, but he wanted to recuperate at home. A month later, he had severe pain in his lower back and was paralyzed and incontinent. We went to the orthopedic surgery quickly after a few days of anti-TB, and ended up spending 100,000 yuan, still paralyzed, with very little chance of recovery. If he had been treated a year ago, he could have spent 10,000 and gotten better without surgery; if he had come for treatment a month earlier, he could have spent 100,000 and not been paralyzed; but now, after spending 100,000, he is still paralyzed. Think about it, what can we learn from this?