International Orthopaedics

, Volume 36, Issue 2, pp 353–357 | Cite as

Surgical correction of kyphotic deformity in spinal tuberculosis

  • Paul S. Issack
  • Oheneba Boachie-Adjei



Approximately 5% of patients with spinal tuberculosis will develop a severe kyphotic deformity resulting in increased potential for pain, spinal cord compression, cardiopulmonary dysfunction, costopelvic impingement and cosmetic concerns. This manuscript reviews the evaluation and surgical management of tuberculous kyphosis.


This is a review article.


Risk factors for the development of severe kyphosis include those who develop spinal tuberculosis as children, multiple vertebral body involvement and thoracic spine involvement. These complications can be prevented by early diagnosis and treatment of spinal tubercular lesions at stages with little to no deformity. When tubercular lesions result in progression of kyphosis to more than 50 degrees, the deformity should be surgically corrected to avoid problems associated with sagittal imbalance. There are several operations described for the treatment of kyphosis secondary to tuberculous spondylitis. The type of the operation depends on the magnitude of correction required.


Anterior, posterior and combined techniques as well as osteotomies and vertebral column resection have been described to correct spinal alignment and restore sagittal balance.


Sagittal Balance Posterior Instrumentation Spinal Tuberculosis Kyphotic Deformity Pedicle Subtraction Osteotomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Boachie-Adjei O, Squillante RG (1996) Tuberculosis of the spine. Orthop Clin North Am 27(1):95–103PubMedGoogle Scholar
  2. 2.
    Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 92(7):905–913PubMedCrossRefGoogle Scholar
  3. 3.
    Jain AK, Dhammi IK (2007) Tuberculosis of the spine: a review. Clin Orthop Relat Res 460:39–49PubMedCrossRefGoogle Scholar
  4. 4.
    Jain AK, Dhammi IK, Jain S et al (2010) Kyphosis in spinal tuberculosis—Prevention and correction. Indian J Orthop 44(2):127–136PubMedCrossRefGoogle Scholar
  5. 5.
    Rajasekaran S (2001) The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity. J Bone Joint Surg Br 83(7):954–962PubMedCrossRefGoogle Scholar
  6. 6.
    Rajasekaran S (2007) Buckling collapse of the spine in childhood spinal tuberculosis. Clin Orthop Relat Res 460:86–92PubMedGoogle Scholar
  7. 7.
    Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 71(9):1314–1323PubMedGoogle Scholar
  8. 8.
    Jain AK (2002) Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop Relat Res 398:75–84PubMedCrossRefGoogle Scholar
  9. 9.
    Moon MS, Moon YW, Moon JL et al (2002) Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop Relat Res 398:40–49PubMedCrossRefGoogle Scholar
  10. 10.
    Rajasekaran S (2002) The problem of deformity in spinal tuberculosis. Clin Orthop Relat Res 398:85–92PubMedCrossRefGoogle Scholar
  11. 11.
    Oga M, Arizono T, Takasita M et al (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976) 18(13):1890–1894CrossRefGoogle Scholar
  12. 12.
    Yilmaz C, Selek HY, Gurkan I et al (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 81(9):1261–1267PubMedGoogle Scholar
  13. 13.
    Guven O, Kumano K, Yalcin S et al (1994) A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine (Phila Pa 1976) 19(9):1039–1043CrossRefGoogle Scholar
  14. 14.
    No author listed (1998) A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. Thirteenth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 80(3):456–462CrossRefGoogle Scholar
  15. 15.
    Benli IT, Acaroglu E, Akalin S et al (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12(2):224–234PubMedGoogle Scholar
  16. 16.
    Chacko AG, Moorthy RK, Chandy MJ (2004) The transpedicular approach in the management of thoracic spine tuberculosis: a short-term follow up study. Spine (Phila Pa 1976 29(17):E363–E367CrossRefGoogle Scholar
  17. 17.
    Huang QS, Zheng C, Hu Y et al (2009) One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 33(5):1385–1390PubMedCrossRefGoogle Scholar
  18. 18.
    Lee SH, Sung JK, Park YM (2006) Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series. J Spinal Disord Tech 19(8):595–602PubMedCrossRefGoogle Scholar
  19. 19.
    Louw JA (1990) Spinal tuberculosis with neurological deficit. Treatment with anterior vascularised rib grafts, posterior osteotomies and fusion. J Bone Joint Surg Br 72(4):686–693PubMedGoogle Scholar
  20. 20.
    Ozdemir HM, Us AK, Ogun T (2003) The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine (Phila Pa 1976) 28(5):474–479Google Scholar
  21. 21.
    Talu U, Gogus A, Ozturk C et al (2006) The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. J Spinal Disord Technol 19(8):554–559CrossRefGoogle Scholar
  22. 22.
    Zhang HQ, Guo CF, Xiao XG et al (2007) One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion. J Spinal Disord Technol 20(4):263–267CrossRefGoogle Scholar
  23. 23.
    Zhao J, Lian XF, Hou TS et al (2007) Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly. Int Orthop 31(6):859–863PubMedCrossRefGoogle Scholar
  24. 24.
    Bezer M, Kucukdurmaz F, Guven O (2007) Transpedicular decancellation osteotomy in the treatment of posttuberculous kyphosis. J Spinal Disord Technol 20(3):209–215CrossRefGoogle Scholar
  25. 25.
    Boachie-Adjei O (2006) Role and technique of eggshell osteotomies and vertebral column resections in the treatment of fixed sagittal imbalance. Instr Course Lect 55:583–589PubMedGoogle Scholar
  26. 26.
    Bradford DS, Tribus CB (1997) Vertebral column resection for the treatment of rigid coronal decompensation. Spine (Phila Pa 1976) 22(14):1590–1599CrossRefGoogle Scholar
  27. 27.
    Bridwell KH (2006) Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976) 31(19 Suppl):S171–S178CrossRefGoogle Scholar
  28. 28.
    Deng Y, Lv G, An HS (2009) En bloc spondylectomy for the treatment of spinal tuberculosis with fixed and sharply angulated kyphotic deformity. Spine (Phila Pa 1976) 34(20):2140–2146CrossRefGoogle Scholar
  29. 29.
    Gokce A, Ozturkmen Y, Mutlu S et al (2008) Spinal osteotomy: correcting sagittal balance in tuberculous spondylitis. J Spinal Disord Technol 21(7):484–488CrossRefGoogle Scholar
  30. 30.
    Kalra KP, Dhar SB, Shetty G et al (2006) Pedicle subtraction osteotomy for rigid post-tuberculous kyphosis. J Bone Joint Surg Br 88(7):925–927PubMedCrossRefGoogle Scholar
  31. 31.
    Pappou IP, Papadopoulos EC, Swanson AN et al (2006) Pott disease in the thoracolumbar spine with marked kyphosis and progressive paraplegia necessitating posterior vertebral column resection and anterior reconstruction with a cage. Spine (Phila Pa 1976) 31(4):E123–E127CrossRefGoogle Scholar
  32. 32.
    Smith-Petersen MN, Larson CB, Aufranc OE (1969) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 66:6–9PubMedGoogle Scholar
  33. 33.
    Suk SI, Chung ER, Kim JH et al (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976) 30(14):1682–1687CrossRefGoogle Scholar
  34. 34.
    Suk SI, Kim JH, Kim WJ et al (2002) Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976) 27(21):2374–2382CrossRefGoogle Scholar
  35. 35.
    Thomasen E (1985) Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res 194:142–152PubMedGoogle Scholar
  36. 36.
    Wang Y, Zhang Y, Zhang X et al (2009) Posterior-only multilevel modified vertebral column resection for extremely severe Pott's kyphotic deformity. Eur Spine J 18(10):1436–1441PubMedCrossRefGoogle Scholar
  37. 37.
    Yau AC, Hsu LC, O'Brien JP et al (1974) Tuberculous kyphosis: correction with spinal osteotomy, halo-pelvic distraction, and anterior and posterior fusion. J Bone Joint Surg Am 56(7):1419–1434PubMedGoogle Scholar
  38. 38.
    Dai LY, Jiang LS, Wang W et al (2005) Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976) 30(20):2342–2349CrossRefGoogle Scholar
  39. 39.
    Jain AK, Dhammi IK, Prashad B et al (2008) Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br 90(11):1477–1481PubMedCrossRefGoogle Scholar
  40. 40.
    Frankel HL (1969) Ascending cord lesion in the early stages following spinal injury. Paraplegia 7(2):111–118PubMedCrossRefGoogle Scholar
  41. 41.
    Klimo P Jr, Dailey AT, Fessler RG (2004) Posterior surgical approaches and outcomes in metastatic spine-disease. Neurosurg Clin N Am 15(4):425–435PubMedCrossRefGoogle Scholar
  42. 42.
    Bridwell KH, Lewis SJ, Lenke LG et al (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85-A(3):454–463PubMedGoogle Scholar
  43. 43.
    Bridwell KH, Lewis SJ, Rinella A et al (2004) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am 86-A(Suppl 1):44–50PubMedGoogle Scholar
  44. 44.
    Gill JB, Levin A, Burd T et al (2008) Corrective osteotomies in spine surgery. J Bone Joint Surg Am 90(11):2509–2520PubMedCrossRefGoogle Scholar
  45. 45.
    Smith JS, Sansur CA, Donaldson WF, 3rd, et al (2011) Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: A report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 36(12):958–964Google Scholar
  46. 46.
    Smith JS, Wang VY, Ames CP (2008) Vertebral column resection for rigid spinal deformity. Neurosurgery 63(3 Suppl):177–182PubMedCrossRefGoogle Scholar
  47. 47.
    Joseph SA Jr, Moreno AP, Brandoff J et al (2009) Sagittal plane deformity in the adult patient. J Am Acad Orthop Surg 17(6):378–388PubMedGoogle Scholar
  48. 48.
    Kim HJ, Cunningham ME, Boachie-Adjei O (2010) Revision spine surgery to manage pediatric deformity. J Am Acad Orthop Surg 18(12):739–748PubMedGoogle Scholar
  49. 49.
    Kawahara N, Tomita K, Kobayashi T et al (2005) Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976) 30(6):613–620CrossRefGoogle Scholar
  50. 50.
    Wang Y, Zhang Y, Zhang X et al (2008) A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. Eur Spine J 17(3):361–372PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Hospital for Special Surgery, New YorkNew YorkUSA

Personalised recommendations