Abstract:[Objective] To evaluate the clinical efficacy of anterior surgery versus posterior counterpart in the treatment of thoracic spi- nal tuberculosis. [Methods] Literature retrieval was conducted in seven databases including PubMed, Embase, Cochrane, Web of Science, CKNI, VIP and Wanfang, and relevant journals were manually searched. After reading the full paper and extracting the data met the includ- ing criteria, a meta-analysis was conducted by using Revman 5.3 software. [Results] A total of 9 literatures were enrolled into this study from 11618 retrieved literatures, all of which were retrospective cohort studies. A total of 837 patients were involved, including 318 cases in the anterior approach group and 519 cases in the posterior approach group. As results of the meta-analysis, there were no statistically significant differences between the two groups in terms of operation time, intraoperative blood loss, postoperative Cobb angle correction, bone graft fu- sion time, and neurological function improvement (P＞0.05), however, the posterior group proved significantly superior to the anterior group in terms of complications [OR=2.43, 95%CI 1.50~3.94, P＜0.05] and the correct loss in Cobb angle at the latest follow-up [MD=1.16, 95%CI 0.36~1.95, P＜0.05]. [Conclusion] Both posterior and anterior surgical operations are effective in treating thoracic tuberculosis and restor- ing nerve function. By comparison, the posterior surgery have fewer complications and are more beneficial to the maintenance of kyphotic de- formity correction.