ObjectiveTo assess the clinical efficacy of three different surgical approaches in the treatment of thoracolumbar tuberculosis.MethodsA total of 138 patients with thoracolumbar tuberculosis treated by open surgery were retrospectively analyzed. The surgical methods were divided into anterior, posterior and anterior–posterior combined. The hospital stays, amount of bleeding, operative time, preoperative, postoperative and last follow-up ESR, CRP, Frankel score, ODI, VAS, correction and loss rate of kyphosis, fusion rate and complications were recorded and analyzed.ResultsThe average follow-up was 66 months. The average hospital stay, operative time and amount of bleeding of the anterior–posterior combined group were higher than other groups (P< 0.05). ESR and CRP of all patients were reduced postoperatively (P< 0.05). No significant difference among the three groups was found in the postoperative correction angle of kyphosis (P< 0.05), while the pre- and postoperative Cobb angle as well as correction rate had significant differences. The posterior approach could achieve better correction, and the loss of correction was more in the anterior group, 40.9 percent of patients performed correction loss. The Frankel score, VAS and ODI were significantly reduced among the three groups, and the incidence rate of complications of the anterior approach was lower than the other groups, with a significant difference (P< 0.05).ConclusionThe anterior approach has more advantages and fewer complications, which is supposed to give preference to and could not be replaced by the posterior and anterior–posterior combined approach.