Fig. 1.

Surgical options in correction of severe post-tuberculosis kyphotic deformities. a In healed tuberculosis, there is severe shortening of the anterior column with a relatively normal posterior column. The fusion mass is usually slightly retropulsed and causes indentation of the dura. There may be surrounding peridural fibrosis and the exiting nerve roots are crowded at the level of the fusion mass. b Correction of kyphosis by opening up the kyphosis and restoring the anterior column height has the problem of causing stretching of the cord. c Correction by a pure closing wedge osteotomy by posterior column shortening can result in kinking and herniation of the cord through the laminectomy defect. d An osteotomy that shortens the posterior column and opens up the anterior column appropriately can restore the sagittal alignment without either undue elongation or shortening of the cord