Spinal tuberculosis diseases was similar to internal medicine diseases, and the best basic treatment is chemotherapy, rest, and immobilisation. It was advocated chemotherapy alone at the beginning until Hodgson and Stock advocated debridement and bone grafting fusion surgery . Surgery should be considered in cases of unstable spine to prevent kyphosis, progressive symptoms of spinal cord nerve damage to avoid paralysis. The final neurological improvement is significantly affected by patients suffering from tuberculosis of spine, vertebral involvement, AIS grade, bladder and bowel involvement and its duration . Complete debridement and decompression can reduce the paralysis, re-establish spinal stability and correct the deformity, as well as shorten the treatment cycle, reduce adverse drug reactions, and improve quality of life [11, 12].
Although surgical strategy has significant advantages in terms of preventing kyphosis progression and neurological deficits, surgical treatment also has many disadvantages such as considerable trauma, risk to important organs, blood vessels and nerves, postoperative complications, economic burden and so on. Selecting the appropriate treatment programme for spinal tuberculosis is challenging for surgeons [13, 14]. The choice of surgery or drug therapy has yet been reached an agreement. Many studies have reported satisfactory results for the treatment of spinal tuberculosis with simple chemotherapy, and about 80% of patients achieved spontaneous fusion. Chemotherapy became one essential foundation for the treatment of spinal tuberculosis [15, 16]. The antitubercular drugs are the key stones in the management of tuberculosis of spine, similar as soft tissue tuberculosis management, limited role of surgery . For patients without serious complications, drug chemotherapy can achieve satisfying short and long-term effects. Moreover, the conservative treatment is suitable for most patients, as an early incarnation of the concept of individualised treatment. Bhojraj et al.  reported more than 98% spinal tuberculosis patients can be cured by simple chemotherapy and avoided surgery. No significant difference in functional outcome was found between conservative management and surgery for cases with uncomplicated spinal tuberculosis .
The indication for the conservative treatment of spinal tuberculosis has always been controversial. Conservative treatment should be suitable for patients without obvious kyphosis, spinal instability, and progressive dysfunction of the spinal cord. In our past research, we characterised a subtype of spinal TB called ‘mild spinal TB’ in great detail and selected the study population accordingly to improve the clinical classification and treatment of spinal tuberculosis . In a prospective study by Kotil 44 , patients without neurological deficits and significant kyphosis were treated effectively with anti-tuberculosis drugs. The results showed that 42 patients (95.4%) were clinically cured without any significant kyphosis after only chemotherapy. In our patients, the average number of spinal tuberculosis levels involved was 2.5 (range from one to five levels); this was associated with excellent results by non-surgical treatment for thoracic spinal tuberculosis . Single vertebral involvement with a central lesion or multivertebral involvement (fewer than three) with edge type lesions are indications for conservative treatment. Except for these strict mild spinal tuberculosis standards, we found that patients who underwent CT-guided local chemotherapy for spinal tuberculosis involving four levels with a small paravertebral abscess or psoas gravitation abscess (less than 5 cm in diameter), without obvious kyphosis and no obvious spinal instability. Those patient also achieved satisfactory results by CT puncture treatment.
Although mild kyphosis was observed, there were no obvious symptoms in the two groups. With progress in treatment concepts, mild spinal tuberculosis is no longer treated surgically in recent years, but rather most patients are treated by simple chemotherapy and achieve satisfactory results. The existence of tuberculosis cold abscess always causes toxemia, abnormal inflammatory laboratory indicators, increased consumption and pain. It's theoretically possible that traditional drug chemotherapy is not easy to obtain early control of abscess, the CT puncture treatment can play the purpose of rapid recovery of eliminate pus and pain relief. But in this study, the VAS scores decreased significantly and pain was relieved at follow-up under conservative treatment, with no significant differences between the two groups. It is very likely that patients in the traditional chemotherapy group had less or small abscess, and the chemotherapy drugs could be effectively controlled TB infection in the early stage. Minimally invasive surgery involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with paravertebral or psoas abscesses and spinal tuberculosis .
With the development of the economy, the health consciousness of patients has gradually improved, and various diagnostic techniques have been applied to the clinic. These affordable and simple actions and district levels could facilitate earlier diagnosis . Diagnosis of spinal tuberculosis (TB) in the early (inflammatory) stage is essential to prevent the development of spinal deformity and neurological deficit . Due to this, the early diagnosis rate of spinal tuberculosis has been significantly enhanced. Before the symptoms of kyphosis, gravitation abscess, neurological deficits, and spinal instability occur, patients can be diagnosed and treated early. The CT puncture treatment technique has some advantagesis of less traumatic or risky, beneficial for obtaining specimens, detecting drug resistance and acomplishing early individualised treatment.
One persistent controversy in the treatment of spinal tuberculosis is the absence of a general classification system to guide clinical protocols. In order to standardise treatment strategies, a few researchers have attempted to classify spinal tuberculosis, but this has not been widely accepted because of some shortcomings. The classic pathological types (edge type, central type, sub-ligament type, accessory type) are too simple, making it difficult to guide clinical surgical decisions and prognosis. In 2001, Mehta et al.  divided thoracic vertebrae into four types based on MRI signs, and recommended surgical procedures according to the different type. However, the classification system only included the thoracic vertebrae. In 2008, a retrospective study analysed 76 patients with spinal tuberculosis, and put forward a new classification (GATA) according to abscesses, neurological deficit, vertebral collapse, kyphosis, spinal instability, and disc degeneration . This new classification system is considered to be a practical guide for spinal tuberculosis treatment planning . Nonetheless, the classification does not include spinal adnexal tuberculosis, as this criterion is too complex to master in the clinic. Non-surgical measures have been successful in the treatment of spinal tuberculosis patients without the use for bracing [18, 26].
we found that there was no obvious difference between traditional conservative treatment with drug anti-tuberculous chemotherapy and CT-guided local chemotherapy to delay kyphosis, spinal instability, and neurological deficits in mild spinal tuberculosis by comparison. Although surgical treatment for spinal tuberculosis abscess can lead to satisfactory clinical outcomes . The treatment by CT puncture and catheterisation is minimally invasive, beneficial for the drainage of paravertebral abscesses, and reduce the possibility of conventional surgical debridement for tuberculosis abscesses. Moreover, this strategy reduces tuberculosis infection, consumption, pain, and complications related to prolonged bed rest, also enhanced recovery of mild spinal tuberculosis. Theoretically, it has advantages over single drug chemotherapy in the treatment of abscesses. In particular, it is conducive to test for drug-resistant tuberculosis in abscess specimens to diagnose, guide and adjust the chemotherapy regimen if necessary. Spinal tuberculosis is a global disease, timely diagnosis with clinical, imaging, microbiological, histopathological features and complete course of anti-tubercular treatment along with symptomatic treatment appears to be safe and effective .
Although satisfactory outcomes were obtained in this study, several limitations exist. First, this was a retrospective study without random assignment of patients, a short follow-up period and small sample size, which may affect the reliability of the results. Second, the study did not include patients with neurological deficits, serious kyphosis, or large abscesses, which may cause a certain degree of bias. Third, need random controlled and prospective studies in future with large patient populations to prove.