Abstract:[Objective] To compare the clinical outcomes of debridement and instrumented fusion through posterior approach only ver- sus anterior and posterior approaches for lumbosacral tuberculosis (TB). [Methods] A retrospective study was conducted on 68 patients who received individualized surgical treatment for lumbosacral TB from January 2010 to December 2019. Based on doctor-patient communica- tion, 36 patients had operation performed through the posterior approach only (PA group), while the other 32 patients were through combined anterior and posterior approaches (the APA group). The documents regarding perioperative period, follow-up and auxiliary examination were compared between the two groups. [Results] The overall complication rate was of 7/36 (19.4%) in the PA group, whereas 12/32 (37.5%) in the APA groups. In addition, the PA group proved significantly superior to the APA group in terms of operation time [(222.0±34.0) min vs (312.0±40.4) min, P＜0.001], total incision length [(18.3±3.5) cm vs (34.3±7.0) cm, P＜0.001], intraoperative blood loss [(380.0±152.6) ml vs (490.0±209.3) ml, P＜0.001], intraoperative fluoroscopy [(5.5±0.1) times vs (6.1±0.2) times, P＜0.001], postoperative ambulation [(9.0±0.6) days vs (11.6±0.7) days, P＜0.001], incision healing grade [A/B/C: (36/0/0) vs / (25/7/0), P=0.003) and hospital stay [(17.6±3.2) days vs (20.3± 4.1) days, P=0.003]. All patients were followed up for more than 12 months, and there was no significant difference in the time to return to full weight-bearing activities between the two groups (P＞0.05). The VAS and ODI scores decreased significantly (P＜0.05), whereas the JOA score increased significantly in both groups over time (P＜0.05), which were not significantly different between the two groups at any time points accordingly. In term of lab test, ESR decreased significantly over time in both groups (P＜0.05), with no significant difference between the two groups at any corresponding time points (P＞0.05). Radiographically, the TB lesions in both groups were gradually cured over time (P＜ 0.05), while the lumbar lordosis significantly improved in both groups at 6 months after surgery and at the last follow-up compared to that preoperatively (P＜0.05), and all patients in both groups had osseous fusion of the involved segment at the last follow- up. However, there were no statistically significant differences in lesion revealed on images, lumbar lordosis angle and Bridwell fusion grading between the two groups at any time points accordingly (P＞0.05). [Conclusion] For lumbosacral tuberculosis, the surgical method should be selected accord- ing to the specific conditions, and simple posterior approach should be used as far as possible to reduce the risk of surgical trauma and com- plications.