Journal of neurosurgery. Spine
September 4, 2026 · via Europe PMC
Posterior vertebral column resection at the apical vertebra versus subapical vertebra for tuberculotic angular kyphosis: 100 patients with a minimum 2-year follow-up.
Lu Y, Li Z, Li J, Zhang X, Wang Y, Li W, Yu M
AI summary — for doctors, generated from the abstract only
In a 100-patient study of severe tuberculous angular kyphosis, resecting the vertebra just below the kyphotic apex (subapical) rather than the apex itself achieved similar deformity correction with significantly fewer neurological complications.
What was studied
A retrospective study of 100 patients with rigid tuberculotic angular kyphosis (TAK) who underwent single-level posterior vertebral column resection (pVCR) between June 2010 and June 2023, comparing resection at the apical vertebra (AV group, n=65) versus the subapical vertebra (SAV group, n=35), evaluating radiographic correction, complications, and health-related quality of life (HRQOL) outcomes.
Key findings
- Both groups achieved and maintained significant correction of the sagittal Cobb angle, with no significant difference in radiographic outcomes between groups.
- The SAV group had significantly lower rates of dural tears (11.4% vs 29.2%, p = 0.044), intraoperative neuromonitoring alerts (22.9% vs 44.6%, p = 0.032), and neurological complications including motor deficits (17.1% vs 36.9%, p = 0.040; motor deficits 11.4% vs 29.2%, p = 0.044).
- HRQOL outcomes (Oswestry Disability Index and Japanese Orthopaedic Association score) were better in the SAV group at final follow-up, though the exact p-value is cut off in the available abstract text.
Clinical relevance
The findings suggest that subapical vertebral column resection may be a safer surgical strategy than resecting at the kyphotic apex for severe tuberculous angular kyphosis, achieving comparable deformity correction with fewer neurological complications, which could inform surgical planning for this specific, severe deformity.
Who should care
Limitations
This was a retrospective, non-randomized comparison, which may be subject to selection bias in which patients were assigned to apical versus subapical resection.
Resecting the subapical rather than apical vertebra for severe tuberculous angular kyphosis achieved similar correction with substantially fewer neurological complications in this 100-patient study.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
OBJECTIVE
The authors of this study aimed to compare the surgical outcomes and complication profiles of posterior vertebral column resection (pVCR) performed at the apical vertebra (AV) versus the subapical vertebra (SAV) in patients with rigid tuberculotic angular kyphosis (TAK). They hypothesized that an SAV resection would reduce the incidence of neurological complications without compromising radiographic correction.
METHODS
They conducted a retrospective analysis of patients with TAK who underwent single-level pVCR (Schwab grade 5 osteotomy) between June 2010 and June 2023. Patients were divided into 2 groups, an AV group and SAV group. Demographic, surgical, radiographic, and health-related quality of life (HRQOL) data were collected. Radiographic parameters included sagittal Cobb angle, pelvic incidence, lumbar lordosis, and sagittal vertical axis. HRQOL outcomes were assessed using the visual analog scale, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) functional assessment, and SF-36. Complications, including dural tears, intraoperative neuromonitoring (IONM) alerts, neurological deficits, etc., were recorded and compared.
RESULTS
One hundred patients were eligible for study inclusion, of whom 65 were included in the AV group and 35 in the SAV group. Both groups attained and maintained significant correction of the sagittal Cobb angle postoperatively, with no significant differences in radiographic outcomes between groups. However, the SAV group demonstrated significantly lower rates of dural tears (11.4% vs 29.2%, p = 0.044), IONM alerts (22.9% vs 44.6%, p = 0.032), and neurological complications (17.1% vs 36.9%, p = 0.040), particularly motor deficits (11.4% vs 29.2%, p = 0.044). HRQOL outcomes showed better ODI and JOA scores in the SAV group at the final follow-up (both p < 0.001).
CONCLUSIONS
This study provides clinical evidence that the SAV constitutes a safer and more strategic resection site, as it avoids the severely pathological kyphotic apex and facilitates a more physiologically tolerable correction. Therefore, the subapical VCR strategy is recommended as a viable alternative for managing severe TAK, one that prioritizes patient safety without substantially compromising deformity correction.
DOI
10.3171/2026.3.spine251477
PMID
42696773
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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