Abstract: Objective To investigate the clinical effectiveness 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 total of 53 patients who underwent one-stage thoracic and lumbar tuberculosis focus removal and bone grafting and internal fixation in the Affiliated Hospital of Xuzhou Medical University from July 2015 to June 2017 were enrolled and their clinical data were retrospectively analyzed. Then, 26 patients who were locally treated with rifampicin powder were set as group A, while another 27 patients who received tuberculosis focus removal and bone grafting and internal fixation were set as group B. Both groups were compared for surgical duration, blood loss during surgery and the length of hospitalization. Their erythrocyte sedimentation rate (ESR) and ALT values 1, 3, 7 and 14 days after surgery were detected, and their ESR and ALT values 1, 3, 6, 12 and 18 months after surgery were determined during follow-up visits. Both groups were compared for Cobb angle and spinal injury Frankel scores before and after surgery. Their postoperative recovery and drug adverse reactions were recorded. Results There was no significant difference in surgical duration, blood loss during surgery and the length of hospitalization between the two groups (P>0.05). Their ESR and ALT values were in the normal range one month after surgery, and no statistical difference was found in postoperative ESR and ALT values between the two groups (P>0.05). After surgery, both groups presented remarkably reduced Cobb angle and increased spinal injury Frankel scores, compared with those before surgery (P<0.05). There was no significant difference in the fusion rate and fusion time between the two groups (P>0.05), but the recurrence rate was remarkably lower in group A than group B (P<0.05). No obvious drug adverse reactions were found in all groups. Conclusions One-stage debridement, bone grafting and internal fixation for thoracic and lumbar spinal tuberculosis patients is an effective surgical approach in the treatment of spinal tuberculosis. Combined local use of rifampicin powder can reduce local recurrence rate, which is safe and easy to perform, with certain clinical value.