Abstract: ob＜x＞jective To investigate the clinical effect of one-stage debridement, bone graft and internal fixation combined with local application of rifampicin powder in the treatment of thoracic and lumbar tuberculosis. Methods A retrospective analysis was made on 53 patients who underwent one-stage thoracic and lumbar tuberculosis focus removal and bone grafting and internal fixation surgery in our hospital from July 2015 to June 2017. Among them, 26 patients who underwent combined local application of rifampicin powder were set as group A; Twenty-seven patients in group B were treated with regular antituberculosis therapy in the whole process. The clinical effects of the two groups were compared. Results There was no significant difference between the two groups in terms of operation time, blood loss and hospitalization time (P>0.05). There was no significant difference in ESR value, liver function index and anti-tuberculosis adverse drug reactions between the two groups during postoperative follow-up (P>0.05). The Cobb angle of postoperative kyphosis in the two groups decreased compared with that before operation, and the difference was statistically significant (P<0.05), while there was no statistically significant difference between the two groups (P>0.05). Frankel score of spinal cord nerve injury in the last follow-up of the two groups was higher than that before treatment, and the difference was statistically significant (P<0.05). There was no significant difference in the fusion rate and fusion time between the two groups (P>0.05). There was significant difference in recurrence rate between the two groups (P<0.05). Conclusion One-stage debridement, bone grafting and internal fixation for thoracic and lumbar spinal tuberculosis patients is an effective surgical method for the treatment of spinal tuberculosis. Combined local use of rifampicin powder can reduce the local recurrence rate, and is safe and convenient to operate, which has certain clinical application value