Abstract: Objective To evaluate the curative effect of percutaneous catheter drainage combined with local chemotherapy for spine tuberculosis abscesses in elderly patients (≥65 years).Methods A retrospective analysis of 25 patients older than 65 years with paraspinal abscess and (or) psoas abscess from June 2005 to December 2011 was conducted. On the basis of systemic anti-tuberculosis chemotherapy, all patients received the combination treatment of CT-guided percutaneous catheter drainage and local chemotherapy. The best puncture point was selected with CT. The 18G puncture needle was put through the abscess cavity, double central venous catheter was left into the abscess cavity to take the pus. 500ml 0.9% sodium chloride solution with 0.3g isoniazid was used to rinse the lesion, than the solution by mixing 0.45g rifampin with 0.3g isoniazid was injected into the abscess cavity.Results Twenty-five patients had catheter placed smoothly under CT guidance. No puncture-related complications, such as nerve damage, bleeding, visceral injury and pneumothorax, were detected. During the follow-up period of 6 to 36 months, CT scans of 22 cases showed vertebral lesion absorption, bone density increased, lesions peripheral sclerosis, vertebral edge hyperplasia, paraspinal abscess and (or) psoas abscess disappearance. Erythrocyte sedimentation rate (ESR) was decreased from (58±19) mm/1h on admission to (13±10) mm/1h 6 months after surgery (t=37.557,P=0.000). Another 3 cases stopped taking anti-TB drugs due to severe liver damage during the follow-up. CT scan showed paraspinal abscess narrowed, but vertebral lesion absorption was not obvious, and there were still visible patchy or worm-eaten low-density lesions.Conclusion On the basis of systemic anti-tuberculosis chemotherapy, the combination treatment of CT-guided percutaneous catheter drainage and local chemotherapy was a safe and effective method for spinal tuberculosis in elderly patients (≥65 years).