Fig. 7

A 66-year-old female with post-tuberculous kyphosis underwent vertebral column resection (VCR) at T4–T6 and posterior spinal instrumentation from T1 to T9. During decompression, transient loss of left lower extremity motor evoked potentials (MEPs) was observed, with subsequent recovery; however, right lower extremity MEPs were lost and did not recover by the end of surgery. Immediate postoperative examination revealed preserved left lower extremity motor strength, while the right lower extremity exhibited complete paralysis. By postoperative day 2, right iliopsoas and quadriceps strength improved to grade I, with other muscle groups at grade IV. Further recovery to grade III in the right iliopsoas and quadriceps (other muscles: grade IV) was noted by postoperative day 9. At 5-month follow-up, right lower extremity motor strength had returned to preoperative levels. (a) Preoperative anterior-posterior and (b) lateral whole-spine radiographs demonstrate a T2–T7 kyphotic curve measuring 86.5°, with preserved coronal alignment. The sagittal deformity angular ratio (S-DAR) was calculated as 14.4 (86.5/6), and the sagittal deformity angular distance ratio (S-DADR) was calculated as 19.7 (86.5/4.4). Postoperative 5-month (c) anterior-posterior and (d) lateral radiographs show correction of the kyphotic curve to 41.7°