Objective: Establish a clinical standardized diagnosis and treatment strategy system for senile brucellosis spondylitis, and evaluate the clinical effect of applying this diagnosis and treatment system in order to improve the diagnosis rate and cure rate of the disease. Methods: From January 2002 to December 2017, 70 elderly patients with brucellosis spondylitis were treated, and comprehensively diagnosed by medical history, clinical, imaging, laboratory and pathology. Among them, the positive rates of Rose Bengal Plate Agglutination Test (RBPT), Standard Tube Agglutination Test (SAT) and brucellosis anti-human immunoglobulin test (Coomb’s) were 45.71%, 70% and 100%, respectively. All patients in this group underwent X-ray films, CT and MRI examinations; pathogenic examinations: blood culture, bone marrow culture, and inflammatory granuloma (or abscess) sampling and culture positive rates in the lesion were 17.14%, 39.66%, and 52.38%, respectively. All patients received standardized drug therapy, anti-osteoporosis therapy, and adjuvant hyperbaric oxygen therapy. Among them, 42 patients with neurological impairment received one-stage lesion debridement combined with posterior spinal internal fixation surgery on the basis of drug therapy. The paravertebral abscess area and diseased intervertebral space tissues were taken for pathological examination. According to evaluation items, patients in this group were selected as follow-up and evaluation points at different time points after treatment: 2 weeks, 1 month, 3 months, 6 months and 12 months. Evaluation items include VAS score, imaging score, and clinical efficacy evaluation. SPSS15.0 statistical software package was used for analysis. Results: All patients were confirmed by the above comprehensive examination after admission. In this group, 28 cases (40%) met conservative treatment and received standardized chemotherapy (Group A), and the remaining 42 cases (60%) were complicated with neurological impairment of varying degrees. After 2 to 4 weeks of drug treatment, the symptoms did not improve, and they met the surgical indications and underwent surgical treatment, (Group B). VAS scores showed that there was a statistically significant difference between the two groups at the same time point after treatment (P < 0.05), and group B was superior to group A in terms of time and pain relief. Imaging scores showed that in the late stage of group B, except for the slow bone repair in the debridement area of the original spinal lesion, the spinal lesion segments were stable, and there were no abscesses and inflammatory granulomas; the infiltration of vertebral body lesions and the absorption of intervertebral space infection in group A were not obvious 3 months after treatment, but the inflammatory infiltration of vertebral body and intervertebral space infection gradually absorbed after 6 months. Clinical efficacy evaluation showed that with the passage of time, both groups could obtain good cure rates, and there was statistical significance in clinical cure rates difference between group B and group A (P < 0.05), indicating that both groups of treatment methods had good effects, and group B was better than group A. Conclusion: Elderly brucellosis spondylitis has characteristic manifestations, and the establishment of a standardized diagnosis system will help improve the diagnosis rate; Synchronous drug therapy for BS and osteoporosis according to the treatment strategy has a good effect, and for patients who meet the indications for surgery, timely surgery can relieve or relieve pain, maintain spinal stability, and promote rapid recovery of nerve and spinal functions. It has obvious advantages and can better improve the clinical cure rate.