Objective To investigate the risk factors of postoperative complications in patients with spinal tuberculosis and analyze the value of prognostic nutritional index(PNI)in predicting these complications.Methods The clinical data of 156 patients with spinal tuberculosis who underwent surgery in the Affiliated Hospital of Zunyi Medical University from January 2018 to July 2022 were retrospectively analyzed.The patients were divided into a complication group and a non-complication group based on the presence or absence of postoperative complications.Baseline data,laboratory indicators,and surgery-related indicators were compared between the two groups.The risk factors for postoperative complications in spinal tuberculosis were analyzed,and receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of PNI for postoperative complications in the patients.Results Among all of 156 patients,68 contracted a total of 82 instances of postoperative complications,with an incidence of 43.59%.Coinfection with pulmonary tuberculosis,preoperative anti-tuberculosis treatment duration more than 4 weeks,surgical operation duration,and drainage days were identified as independent risk factors for postoperative complications in spinal tuberculosis(P<0.05).On the other hand,a higher PNI was found to be a protective factor against postoperative complications of the spinal tuberculosis(P<0.05).The area under the ROC curve for PNI predicting postoperative complications ofthe spinal tuberculosis was 0.805.Conclusion The risk of postoperative complications in patients with spinal tuberculosis is subject to such factors ascoexistence of pulmo-nary tuberculosis,preoperative anti-tuberculosis treatment duration,surgery duration,drainage duration,and preoperative PNI.Preoperative PNI has a certain value for predicting the postoperative complications in the patients.