Abstract: Objective Intraoperative cerebral regional oxygen saturation monitoring(rSO₂) was monitored in elderly patients with spinal tuberculosis surgery in order to investigate the relationship between intraoperative rSO₂ and postoperative delirium(POD). Methods Sixty patients with thoracolumbar spine tuberculosis surgery from January to December 2017 in Hangzhou Red Cross Hospital were selected, and divided into POD group(13 patients) and non-POD group(47 patients) according to whether or not POD occurred. Sixty patients with elderly thoracolumbar spine tuberculosis from July to December 2018 were selected, and divided into intervention group and non-intervention group accorded to the random number method with 30 cases in each group. The delirium evaluation scale was used for evaluation of POD. In the intervention group, the cerebral perfusion was adjusted according to the intraoperative rSO₂ value to make the left brain rSO₂ not lower than 20% of the preoperative value. The preoperative and intraoperative left and right brain rSO₂ values were monitored. Results There were no significant differences in the values of left and right brain rSO₂ between the two groups before surgery(P>0.05). During the operation, the proportion of left brain rSO₂ decreased by 20% in the POD group(38.46%) was higher than that in the non-POD group(χ²=5.863, P<0.05). There was no significant difference in the proportion of rSO₂ in the right brain between the two groups(P>0.05). There were no significant differences in the values of left and right brain rSO₂ scores between the two groups before surgery(all P>0.05). During operation, the lowest rSO₂ in the left brain of the intervention group[(68.08±6.68)%] was higher than that in the non-intervention group(t=17.597, P<0.05). There were no significant difference in the lowest rSO₂ between the two groups(P>0.05). The incidence of POD(3.33%) was lower than that of the non-intervention group(χ²=6.405, P<0.05). Conclusion Intraoperative rSO₂ is associated with postoperative POD in elderly patients with spinal tuberculosis. Intervention of rSO₂ can effectively reduce postoperative POD.