Posterior-Only Approach for the Correction of Severe Post-tubercular Kyphosis

Tuberculosis of the vertebral column (Pott's disease) accounts for up to one-half of musculoskeletal tuberculous infections. The eradication of the infective organism (Mycobacterium tuberculosis) is achievable with chemotherapy. However, such patients with spinal tuberculosis are at risk of developing spinal deformity, and 3%-5% of the patients develop severe deformity greater than 60°. A 30-year-old female presented with back pain of 11 years, discharging sinus, and progressively worsening kyphotic deformity of eight-year duration. She had completed a full course of anti-tubercular chemotherapy. Her neurological examination was within normal limits. Antero-posterior and lateral view radiographs showed osteolytic destruction and collapsed T12 and L1 vertebrae with a thoracic kyphosis of 90°. We did a single-stage posterior-approach closing-opening osteotomy surgery utilizing costotransversectomy (T12 and L1 corpectomy, the insertion of expandable titanium cage, T10 to L3 pedicle screw, and rod fusion). Postoperative kyphosis was 25°. Her motor and sensory functions remained preserved following surgery. The duration of follow-up was 18 months post operation. The mainstay of treatment of severe post-tubercular kyphosis (PTK) is surgery. The correction is complex and could be staged or with multiple approaches and consequent high risk of complications. A single-stage posterior-approach surgery is less invasive.