Objectives: The surgical approaches to cervicothoracic spinal tuberculosis (CTSTB) were controversial.The aim of this research is to retrospectively compare the efficacy and feasibility of anterior-only (AO) approach,combined anterior and posterior (AP) surgeries,and posterior-only (PO) approach for the treatment of CTSTB.Methods: AO approach was undertaken in 20 patients (group A),AP fusion was carried out in 18 patients (group B),and PO surgery was performed in 21 patients (group C).Surgery duration,intraoperative blood loss,length of hospitalization,neurological status,kyphosis angle correction,loss of correction,and complications of the three groups were compared.Results: Three surgical approaches all improved the kyphosis deformity and neurological function significantly (P< 0.05).The mean loss of correction in group A in the final follow-up was higher than in groups B and C (P < 0.05),and the difference between groups B and C was not significant (P > 0.05).The mean operation time,blood loss,and hospitalization days in group B were greater than in groups A and C.Complications were most prevalent in group A,more in group B,and the least in group C.Conclusion: The AO approach surgery should be limitedly used for severe CTSTB.The AP approach had got satisfactory clinical and radiographic outcomes,but with larger trauma and more complications,which should be reservedly performed for mild CTSTB.Compared to traditional surgery,PO surgery can significantly improve clinical results and obviously relieve postoperative complications.