Surgical strategy for correction of severe, rigid, post-tubercular cervical kyphosis: an experience of two cases

Case series. To describe a novel surgical strategy for severe, rigid post-tubercular cervical kyphosis with treatment outcomes in two patients. Spinal tuberculosis is a common cause of kyphotic deformity in the developing world with 3–5% of non-operatively managed patients ending up with kyphosis exceeding 60°. Ventral, dorsal and combined approaches have been described for cervical kyphosis, but there is no established surgical strategy for severe, rigid post-tubercular cervical kyphosis. We operated on two girls with severe, rigid cervical kyphosis with preoperative kyphosis measuring 98° and 62°. Our surgical strategy included a three-step approach in the same sitting—(1) An anterior approach to osteotomize the fused vertebral body mass, decompress the spinal cord ventrally and place a temporary cage to stabilize the spine, (2) A posterior approach to osteotomize the fused facets and decompress the cord dorsally. With the completion of the osteotomy, a combination of pedicle screws and lateral mass screws was used to correct the deformity via an anterior opening, posterior closing type of osteotomy. This was followed by, (3) An anterior approach to replace the corpectomy cage with a larger one supplemented with an anterior cervical plate. Our 540° approach achieved a substantial improvement in each of the clinical and radiological parameters we measured, viz. C2–C7 lordosis angle, C2–C7 sagittal vertical axis, neck tilt and Neck Disability Index. For severe, rigid post-tubercular cervical spine kyphosis, a three-step, anterior–posterior–anterior procedure can be used for achieving acceptable correction, improving symptoms and avoiding further progression. IV.