Modified posterior vertebral column resection for extremely severe post-tubercular kyphosis in adults: a two-year follow-up.

Abstract

To describe the clinical and radiographic outcomes of patients with severe post-tubercular kyphosis (PTK) in adults who underwent modified posterior vertebral column resection (mPVCR). A retrospective analysis was conducted on data from 22 patients with severe PTK who underwent surgical treatment. All patients received a one-stage mPVCR deformity correction. General information, radiological parameters including kyphosis angle (KA) and sagittal vertical axis (SVA), functional outcomes including America Spinal Injury Association (ASIA) grades, Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22) scores, and complications were recorded. The mean age of the population was 33.6 ± 11.6 years (range: 18-59 years). The average operation time was 383.2 ± 53.8 min, and the mean intraoperative blood loss was 1652.3 ± 331.8 ml. Significant changes in KA (preoperative: 129.5 ± 17.3° vs. postoperative: 43.7 ± 7.6°; p < 0.001) and SVA (preoperative: 30.9 ± 7.5 mm vs. postoperative: 15.0 ± 4.1 mm; p < 0.001) were observed after the surgery. In addition, the mean SRS-22 scores improved following surgical correction, with the most significant improvement in the self-image domain. The overall complication rate was 36.4%, including 6 non-neurological and 2 neurological complications. Although two patients experienced transient neurological deterioration postoperatively, a significant improvement in patients' ASIA grades and ODI scores was found at final follow-up compared to preoperative values. Modified PVCR represents a safe surgical option for patients with extremely severe PTK requiring aggressive correction. Delayed resection of the posterior elements may contribute to reducing intraoperative blood loss and iatrogenic spinal cord injury during osteotomy. Appropriate correction, while avoiding overcorrection, is beneficial for decreasing neurologic complications.