Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 17 of 18 in Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
Vertebral Column Resection: Correcting Severe Spinal Deformity From Neglected Tuberculosis
August 5, 2026
Vertebral column resection can correct even severe, 90-degree spinal deformity caused by childhood spinal tuberculosis, restoring independent walking within a year in cases that were previously wheelchair-bound. This is one of the most complex procedures in spine surgery, and is only performed at high-volume, well-resourced spinal centres.
How untreated tuberculosis can deform the spine
In one case, a girl from Niger developed spinal tuberculosis at age five or six, which destroyed one of her thoracic vertebrae. She healed with anti-tubercular medication, but as she continued to grow with a missing vertebra, her spine grew in the wrong direction, producing a 90-degree perpendicular curve and a hump, known as a gibbus, by the time she was ten.
Why the deformity became dangerous
The internal gibbus deformity stretched her spinal cord, leading to spastic weakness in both legs and urinary frequency and urgency with difficulty controlling urination, signs that prompted referral for surgery.
How vertebral column resection is performed
Vertebral column resection involves removing the gibbus and the entire affected vertebra from the front of the spine to decompress the spinal cord, placing a mesh cage, and performing a correction, followed by physiotherapy. The procedure takes 8 to 12 hours and is considered one of the toughest operations in spine surgery, only suitable for centres that perform a high volume of complex spinal deformity cases.
Outcome after surgery
The girl from Niger, who had been wheelchair-bound before surgery, achieved independent walking without any aid within a year, having improved markedly in the first three months, along with good control of her bladder. This outcome illustrates what vertebral column resection can achieve even in severe, longstanding deformity.
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This article is based on a Jivo Masterclass session conducted by Dr. Puneet Girdhar, Chairman, Max Institute of Robotics and Minimal Invasive Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass — Dr. Puneet Girdhar taught doctors across Africa on August 10, 2025.
FROM THE LIVE Q&A
Dr. Frank, referring physician, Ghana
I wanted to share how Paulina has been doing since her surgery with you — honestly speaking, I was really impressed by her recovery time. She's come back to Ghana and she's always praising your team, and now I have even more patients lining up who also want to come and have a consultation, and possibly the surgery, after hearing about her experience.
Dr. Puneet Girdhar
We feel privileged to be treating your patient, and I hope we have done justice to you, your practice and of course the patient. I think at the end of the day we all have one common goal — we want to see our patients happy. Otherwise you, me and Jivo would not be here on a Sunday evening, leaving our families aside, if we did not have this goal.
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Frequently Asked Questions
I'm also trying to go into orthopedic surgery myself, and I'm really happy learning more about it and seeing the advances in the surgery you're doing. Out of curiosity — how many of your own fellows go on to specialize in spine surgery after training under you?▼
I always joke about this with my orthopedic fellows. I've had an orthopedic training program for the last 13 or 14 years, and not even one of them has opted for spine surgery as a career — they're very happy doing a knee replacement, arthroscopy, or a fracture nail instead. Spine surgery has evolved so much that the moment they look into the scope, everything is very tiny, and that can be discouraging — it looks very uphill. It takes a little while to enter the system and understand what's going on through keyholes; one has to be patient, because it has a steep learning curve and the margin of error is not there. So for the last four years I've run a dedicated fellowship national training program for spine fellows — once they're selected and come to me, they don't have the option to go to any other theatre, because they're now committed to spine surgery for the rest of their life.
I wanted to share how Paulina has been doing since her surgery with you — honestly speaking, I was really impressed by her recovery time. She's come back to Ghana and she's always praising your team, and now I have even more patients lining up who also want to come and have a consultation, and possibly the surgery, after hearing about her experience.▼
We feel privileged to be treating your patient, and I hope we have done justice to you, your practice and of course the patient. I think at the end of the day we all have one common goal — we want to see our patients happy. Otherwise you, me and Jivo would not be here on a Sunday evening, leaving our families aside, if we did not have this goal.
What is vertebral column resection?▼
It is a procedure that removes a gibbus deformity and the entire affected vertebra from the front of the spine to decompress the spinal cord, followed by placement of a mesh cage, correction and physiotherapy.
How can untreated childhood spinal tuberculosis lead to severe deformity?▼
Tuberculosis can destroy a vertebra in early childhood. Even after healing with medication, the spine continues to grow in the wrong direction around the missing vertebra, producing a severe perpendicular curve and a hump, known as a gibbus, over several years.
What symptoms can a severe spinal gibbus deformity cause?▼
An internal gibbus can stretch the spinal cord, leading to spastic weakness in both legs and urinary frequency and urgency with difficulty controlling urination.
How long does vertebral column resection take?▼
The procedure takes 8 to 12 hours and is considered one of the toughest operations in spine surgery, only suitable for centres that perform a high volume of complex spinal deformity cases.
What outcomes are possible after vertebral column resection for severe deformity?▼
One patient who had been wheelchair-bound before surgery achieved independent walking without any aid within a year, with marked improvement in the first three months and good bladder control.
In This Series: Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
- 1.Advances in Spinal Surgery
- 2.Biportal Endoscopic Spine Surgery: What It Is and How It Works
- 3.Cervical Disc Replacement: Treating Neck Disc Herniation While Preserving Motion
- 4.Growth Rods for Early-Onset Scoliosis in Young Children
- 5.Hemivertebra: Why Early Surgery Prevents Severe Spinal Deformity
- 6.Herniated Disc Surgery: Biportal Endoscopic Discectomy Explained
- 7.Kyphoplasty for Osteoporotic Spinal Fractures: A Same-Day Procedure
- 8.Lumbar Canal Stenosis: Symptoms and Modern Minimally Invasive Treatment
- 9.Minimally Invasive Spinal Fusion: Treating Spinal Instability Without Open Surgery
- 10.Minimally Invasive vs Open Spine Surgery: How Techniques Have Evolved
- 11.Navigation and Robotics in Spine Surgery: Why They Improve Accuracy and Safety
- 12.Prolonged Sitting and Disc Degeneration: Why Desk Jobs Are a Spine Risk
- 13.Recovery After Minimally Invasive Spine Surgery: What Patients Can Expect
- 14.Robotic Spine Surgery for Complex and Revision Cases
- 15.Scoliosis and Kyphosis in Children: Types and Warning Signs
- 16.Scoliosis Treatment: When Observation, Bracing or Surgery Is Needed
- 17.Vertebral Column Resection: Correcting Severe Spinal Deformity From Neglected Tuberculosis
- 18.When to See a Spine Specialist: Warning Signs You Shouldn't Ignore