Skip to main content

Neurological recovery in patients of old healed tubercular rigid kyphosis with myelopathy treated with transpedicular decancellation osteotomy



The purpose of the study was to find out if transpedicular decancellation osteotomy (TDO) is recommendable for neurological recovery in patients with myelopathy due to tubercular rigid kyphosis. We have analyzed the pattern of recovery seen after the surgery and also made an effort to correlate the neurological recovery with preoperative clinical and radiological features.


The clinical parameters used were (1) ASIA impairment scale for motor and sensory function, (2) sphincter dysfunction score, (3) time duration from the onset of myelopathy till the date of surgery, and (4) SRS 30 outcomes questionnaire. Radiological parameters used were (1) Cobb’s angle in standing/sitting radiographs, (2) levels of gibbus, (3) cord changes in sagittal T2 MRI images, and (4) percentage of cord compression. Assessment was done preoperatively and at 1 month, 3 months, 6 months, 1 year and at 2 years postoperatively.


Seventeen patients were included. The follow-up period was 2 years. We had one patient in ASIA A, nine patients in ASIA C and seven patients in ASIA D. Four patients with ASIA C presented with mild sphincter disturbance (score 2) and one presented with severe disturbance (score 1). The ASIA A patient had complete retention (score 0). The ASIA impairment scale improved after surgery, with maximum improvement at 3 months and improvement continuing up to 6 months. 16 (94 %) patients had improvement in lower limb function and 5 (83 %) patients had improvement of sphincter function. 94 % patients had neurological recovery after the operation. The neurological recovery reached a plateau at 6 months with no significant improvement in the further follow-up. Preoperative MRI changes, cord compression and duration from onset of myelopathy to day of surgery were not predictive of the final neurological outcome after surgery.


TDO gives good results in delayed onset neurological deficits in caries spine with rigid kyphosis. At least, one grade improvement in the neurological status of patients with ASIA C and ASIA D can be expected. Maximum improvement in the neurology is seen in the first 3 months and up to 6 months from the date of surgery, without much improvement thereafter.

Level of evidence Level IV.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Tuli SM (1995) Severe kyphotic deformity in tuberculosis of the spine. Int Orthop 19:327–331

    PubMed  Article  CAS  Google Scholar 

  2. Hsu LC, Cheng CL, Leong JC (1988) Pott’s paraplegia of late onset. The cause of compression and results after anterior decompression. J Bone Joint Surg Br 70:534–538

    PubMed  CAS  Google Scholar 

  3. Bilsel N, Aydingöz O, Hanci M, Erdogan F (2000) Late onset Pott’s paraplegia. Spinal Cord 38:669–674

    PubMed  Article  CAS  Google Scholar 

  4. Paravastu R (2008) Paraplegia of late onset in adolescents with healed childhood caries of dorsal spine: a cause of pressure on the cord and treatment. Indian J Orthop 42:454–459

    PubMed  Article  Google Scholar 

  5. Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27:2374–2382

    PubMed  Article  Google Scholar 

  6. Rajasekaran S, Vijay K, Shetty AP (2010) Single-stage closing-opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine: a 3-year follow-up of 17 patients. Eur Spine J 19:583–592

    PubMed  Article  CAS  Google Scholar 

  7. Gokce A, Ozturkmen Y, Mutlu S, Caniklioğlu M (2008) Spinal osteotomy: correcting sagittal balance in tuberculous spondylitis. J Spinal Disord Tech 21:484–488

    PubMed  Article  Google Scholar 

  8. Kalra KP, Dhar SB, Shetty G, Dhariwal Q (2006) Pedicle subtraction osteotomy for rigid post-tuberculous kyphosis. J Bone Joint Surg Br 88-B:925–927

    Article  Google Scholar 

  9. Bezer M, Kucukdurmaz F, Guven O (2007) Transpedicular decancellation osteotomy in the treatment of posttuberculous kyphosis. J Spinal Disord Tech 20:209–215

    PubMed  Article  Google Scholar 

  10. Jain AK (2002) Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop Relat Res 398:75–84

    PubMed  Article  Google Scholar 

  11. 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 83:954–962

    PubMed  Article  CAS  Google Scholar 

  12. Jain AK, Dhammi IK, Prashad B, Sinha S, Mishra P (2008) Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br 90:1477–1481

    PubMed  Article  CAS  Google Scholar 

  13. Laheri VJ, Bhade NP, Dewnany GT (2001) Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord 39:429–436

    PubMed  Article  CAS  Google Scholar 

  14. Moon MS, Moon JL, Moon YW, Kim SS, Kim SS, Sun DH, Choi WT (2003) Pott’s paraplegia in patients with severely deformed dorsal or dorsolumbar spines: treatment and prognosis. Spinal Cord 41:164–171

    PubMed  Article  Google Scholar 

  15. Chatley A, Kumar R, Jain VK, Behari S, Sahu RN (2009) Effect of spinal cord signal intensity changes on clinical outcome after surgery for cervical spondylotic myelopathy. J Neurosurg Spine 11:562–567

    PubMed  Article  Google Scholar 

  16. Lammertse D, Dungan D, Dreisbach J, Falci S, Flanders A, Marino R, Schwartz E, National Institute on Disability and Rehabilitation (2007) Neuroimaging in traumatic spinal cord injury: an evidence-based review for clinical practice and research. J Spinal Cord Med 30:205–214

    PubMed  Google Scholar 

  17. Dunn R, Zondagh I, Candy S (2011) Spinal tuberculosis: magnetic resonance imaging and neurological impairment. Spine 36:469–473

    PubMed  Article  Google Scholar 

  18. Sai Kiran NA, Vaishya S, Kale SS, Sharma BS, Mahapatra AK (2007) Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine 6:320–326

    PubMed  Article  Google Scholar 

  19. Jain AK, Jena A, Dhammi IK (2000) Correlation of clinical course with magnetic resonance imaging in tuberculous myelopathy. Neurol India 48:132–139

    PubMed  CAS  Google Scholar 

Download references


No benefits received or will be received from any commercial party related directly or indirectly to the subject of this manuscript.

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Sreeramalingam Rathinavelu.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Basu, S., Rathinavelu, S. Neurological recovery in patients of old healed tubercular rigid kyphosis with myelopathy treated with transpedicular decancellation osteotomy. Eur Spine J 21, 2011–2018 (2012).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Tuberculous
  • Kyphosis
  • Neurological recovery
  • Transpedicular decancellation osteotomy