Purpose To compare the clinical outcomes of surgical management by posterior only and combined posterior and anterior approaches for thoracic spinal tuberculosis in the elderly.Materials and methods This was a retrospective cohort study.Thirty-six cases of thoracic spinal tuberculosis treated by two different surgical procedures in our center from January 2004 to June 2009 were studied.All the cases were divided into two groups: 20 cases in Group A underwent single-stage posterior debridement,transfora-minal fusion and instrumentation,and 16 cases in Group B underwent posterior instrumentation,anterior debridement and bone graft in a single-or two-stage procedure.The operation time,blood loss,correction rate,recovery of neurological function,fusion time and complications were,respectively,compared between Group A and Group B.Results All patients were followed up for an average of 35.1 ± 5.8 months (range 26-45 months).It was obvi-ously that the average operative duration,blood loss,hos-pitalization and complication rate of Group A was less than those of Group B.Spinal tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients.There was no persistence or recurrence of infec-tion and no differences in the radiological results in both groups.The kyphosis was significantly corrected after surgical management.However,loss of correction also occurred in both groups.Conclusion Our study showed that the posterior approach only procedure obtained better clinical outcomes than combined posterior and anterior surgeries.It might be a better surgical treatment for thoracic spinal tuberculosis in aged patients with poor health status,especially for cases in early phase of bone destruction and/or mild and moderate kyphosis.