[Objective] to analyze the advantages and disadvantages of different posterior distal fixation systems in the surgical treatment of lumbosacral tuberculosis. [Methods] from March 2018 to February 2022, the clinical data of 12 patients with lumbosacral tuberculosis who underwent surgical treatment in Zhengzhou Orthopaedic Hospital were collected and analyzed retrospectively. Posterior debridement, bone graft and internal fixation were performed in 7 cases;anterior debridement, bone graft and posterior internal fixation in 5 cases. Distal fixation only reached to S1 in 7 cases;4 cases to S2,2 cases used S2 lateral mass screws, 2 cases used S2AI screws; 1 case used ilium screws. [Results]all patients had complete follow-up data, 9 patients had good prognosis and 3 patients had poor prognosis. internal fixation failure and non-fusion occurred in the 3 cases. Among them, 2 cases were treated by posterior operation and distal fixation to S1,1 case was treated by combined anterior and posterior approaches and distal fixation was a single iliac screw. [Conclusion]rigid internal fixation is an important aspect to ensure the curative effect of lumbosacral tuberculosis, and it is very important to choose the reasonable fixation system.