[Objective] To explore and analyze the indications, advantages, disadvantages and clinical effects of combined anterior and posterior with posterior only approach for the treatment of lumbosacral spinal tuberculosis. [Method]A total of 68 patients with lumbosacral tuberculosis were treated surgically from January 2010 to December 2019, including 29 males and 39 females. The age ranged from 21 to 68 years. According to the individualized imaging manifestations,32 patients (groupA) were underwent combined anterior and posterior approach operation and the rest 36 patients(groupB) were underwent posterior only approach operation.Postoperative anti-tuberculosis treatment was regular for 12 months,and follow-up was performed to evaluate the curative effect according to laboratory examination, fusion rate of bone graft, correction of deformity and improvement of clinical symptoms (VAS score ,JOA score and ODI score).[Results]Compared with pre-operation, ESR, VAS score, JOA score and ODI score were significantly decreased in all cases over time (P<0.05). 68 cases were followed up for 12-48 months. The fusion rate of bone graft reached 100%. There was no significant difference in postoperative lumbar lordosis angle between the two groups (P>0.05).There were 2 major complications,10 minor complications in group A,and 7 minor complications in group B.[Conclusion]Reasonable selection of individualized surgical treatment according to patients' conditions were effective and safe for lumbosacral spinal tuberculosis.Vascular injury should be noted during anterior approch.