Objective: To review and compare the long-term clinical efficacy between anterior and posterior approaches in the treatment of thoracolumbar tuberculosis. Methods: 138 patients with thoracolumbar tuberculosis treated surgically from September 2009 to September 2017 were reviewed. According to the different approaches, they were divided into anterior surgery and posterior surgery. The hospitalization days, bleeding volume, operation time, erythrocyte sedimentation rate and hypersensitive C-reactive protein, Frankel nerve injury grade, Oswestry dysfunction index (ODI), visual analogue pain score (VAS), kyphosis correction rate, kyphosis correction loss, clinical healing rate and complications were analyzed and compared. Results: 86 cases (138) were followed up, 44 cases were anterior, 42 cases were posterior. The average follow-up time was 66 months (16-108 months). There was no significant difference in baseline values between the two groups (spss 22.0). All patients were cured clinically. General data: The average hospitalization time, operation time and bleeding volume of patients in anterior group were significantly lower than those in posterior groups (P < 0.05). Biochemical indicators: ESR and CRP in the two groups were significantly lower than those before operation (P < 0.05). Imaging indicators: There was significant difference in kyphosis angle before and after operation in each of the two groups. There was no significant difference in kyphosis angle between the two groups (P > 0.05). There was significant difference in kyphosis correction rate beween the two groups. The effect of posterior surgery was better than anterior surgery. Part of the anterior patients showed loss of kyphotic angle correction during follow-up. Functional indicators: Frankel, VAS and ODI of the two groups were significantly lower than those before operation (P < 0.05). There was no significant difference in Frankel score and clinical healing rate between the two groups. Complications: The incidence of surgical complications in the two groups was significantly different (P < 0.05), and the incidence of anterior complications was lower than those in posterior surgery. Conclusion: Compared with the posterior approaches, the anterior approach has more advantages and fewer complications, so the anterior approach should be preferred. The posterior approaches have many disadvantages and high complications, which can not replace the anterior approach.