32 Osteotomies in Spinal Tuberculosis—Adult Care

Kyphosis is one of the major adverse sequelae of spinal tuberculosis. Since the disease is predominantly destroying the vertebral body and is chronic and progressive, most patients have kyphosis of varying degrees, even at first presentation. Patients younger than 10 years with severe disease, contiguous multilevel destruction, and thoracolumbar disease are more prone to severe kyphosis. Posttubercular kyphosis can result in cosmetic disfigurement, painful costopelvic impingement, respiratory complications, and neurologic deficit due to chronic cord compression. Corrective surgery in the form of osteotomy is often required in both the active and the healed stages. In patients with kyphosis and active disease, the aims of surgery are debridement, stabilization, and anterior reconstruction so that the spine heals in appropriate sagittal alignment. This can be performed through direct anterior corpectomy and stabilization, a posterior-only approach for anterior decompression/reconstruction and posterior stabilization, and combined anterior and posterior reconstruction performed through two separate approaches. In the healed stages, patients present with either severe kyphosis alone or with neurologic deficit. Corrective osteotomy is performed to correct the kyphosis within safe limits for normal functioning of the spinal cord. This can be performed through posterior vertebral column resection, pedicle subtraction osteotomy, and closing-opening wedge osteotomy.