Severe Kyphotic Deformity Involving Thoracolumbar Region – A Management Dilemma

Thoracolumbar kyphosis is common cause of sagittal spinal malalignment. Neglected tuberculous infection in childhood often presents as kyphotic deformity in adulthood, especially in India, where tuberculosis is endemic. Complete clinical and radiological evaluation is necessary to decide need for surgical intervention. We came across this case of severe thoracolumbar kyphosis extending into lower lumbar spine due to block vertebra formation from fusion of T12 to L4 vertebrae.The patient presented with debilitating mechanical low back pain without any neurological abnormality in lower limb. The patient was treated surgically with posterior corrective three-column osteotomy and fixation in view of the persistent mechanical low back pain. At 1-year follow-up, the patient showed significant improvement in low back disability score.After performing three-column osteotomy, we obtained 63% correction in thoracolumbar kyphosis resulting in relief of symptomatic severe axial low back pain and ambulatory capacity with Oswestry Disability Score of 10%. This case highlights long-term natural history of neglected post-tuberculous affection of thoracolumbar region of vertebral column and management challenges of severe thoracolumbar kyphosis.