Objective: To research the selection and effect comparison of different surgical approaches for thoracolumbar spinal tuberculosis. Methods: The clinical data of 80 elderly patients with thoracolumbar spinal tuberculosis from September 2015 to December 2018 were retrospectively analyzed. Grouping based on different surgical methods ：Anterior Group（n=33），Posterior group（n=26） and Combined approach group（n=21）. The perioperative situation，follow-up results and imaging evaluation before and after surgery were compared between the three group. Results:（1）The operation time，intraoperative bleeding volume and hospitalization time of the combined approach group were longer than those of the other two groups，with statistical significance（P<0.05）；（2）ESR and C-reactive protein levels in the three groups were better than those before （P<0.05），but there was no significant difference between the three groups （P>0.05）；The ASIA scores of the three groups were better than those before (P < 0.05), but there was no significant difference between the three groups (P > 0.05)；（3）The Cobb angle and loss rate in the anterior group were higher than those in the other two groups，and the correction rate was lower than that in the other two groups，with statistical significance（P<0.05）. Conclusion: Three different surgical approaches for thoracolumbar spinal tuberculosis has good therapeutic effect in elderly patients. As long as the surgical indications are correct，it can effectively remove the lesion，reconstruct the stability of the spine，correct the deformity and achieve satisfactory outcome.