Complex & Severe Spinal Deformity Correction

Most spinal deformities can be managed with observation, bracing, or standard corrective surgery. A small number cannot. When a curve is very large, sharply angled, rigid, or complicated by previous surgery or abnormal anatomy, it may need one of the most demanding operations in the whole of spine surgery: a vertebral column resection. This page explains what that involves and the refined technique Dr. Garg developed for it.

What complex deformity correction involves

In a vertebral column resection (VCR), the surgeon removes an entire segment of the spinal column — both the body of the vertebra at the front and the bony elements at the back — and then shortens and realigns the spine around the spinal cord, fixing it in its new position with instrumentation and fusion. Because so much can be corrected in a single operation, VCR is reserved for deformities that no lesser procedure can safely address.

Performing this from the back alone — a posterior vertebral column resection (PVCR) — avoids the need to also open the chest or abdomen, but it is technically exacting: the spinal cord is exposed and must be protected at every step.

Who is a candidate?

Complex deformity correction is considered for carefully selected patients, typically those with:

• Severe, rigid curves that do not correct adequately on bending X-rays
• Sharp, angular (kyphotic) deformities, including those caused by old infection, trauma, or congenital malformation
• Failed or inadequate previous surgery, where the spine has gone on to deteriorate
• Deformity that is causing imbalance, pain, or pressure on the spinal cord and nerves

It is not a routine operation, and the decision to proceed follows a thorough assessment of the deformity, the patient’s general health, and the balance of risk and benefit.

How the procedure is performed

The operation is planned in detail in advance, often with full-length imaging and three-dimensional reconstruction of the anatomy. In broad terms:

1. The spine is exposed through a single posterior (back) approach.
2. Instrumentation is placed above and below the segment to be removed, to control the spine.
3. The targeted vertebral segment is carefully resected while the spinal cord is protected.
4. The spine is shortened and realigned into a balanced position.
5. The correction is held with rods and screws, and bone graft is added to achieve a solid fusion.

Throughout, continuous spinal-cord monitoring is used to give early warning of any threat to neurological function, so that the surgical team can respond immediately.

Benefits and risks

The benefit of VCR is the ability to correct deformities that are otherwise uncorrectable, to restore balance, and to halt progression. Against this must be weighed the real risks of any major deformity operation: neurological injury, significant blood loss, the possibility of incomplete correction or the need for further surgery, and the general risks of prolonged anaesthesia and major surgery. These are discussed openly and individually before any decision — the aim is always to ensure the expected benefit clearly justifies the risk for that particular patient.

Alternatives

Depending on the deformity, alternatives may include lesser corrective procedures (such as osteotomies that remove a smaller wedge of bone), growth-friendly techniques in children, or — where the deformity is not causing harm — continued non-surgical management and monitoring. Part of the value of a specialist assessment is to determine whether the most extensive option is genuinely necessary or whether a smaller procedure will suffice.

Recovery and outlook

Patients are usually helped to stand and walk within a few days, with recovery then continuing over several months as strength returns and the fusion consolidates. Timelines are individual and depend on the extent of surgery and the patient’s general health. The goal is a safe, balanced spine and prevention of further deterioration, with substantial improvement in the deformity.

Dr. Garg’s approach & experience

Dr. Garg’s Modified Posterior Vertebral Column Resection is a refinement of this operation developed and refined at AIIMS over roughly seven years, with the explicit aim of making an exceptionally demanding procedure safer and more reproducible. The technique and its results were published in The Spine Journal in 2020, and in 2026 the work drew national press attention as a safer, more reliable approach for patients with severe spinal deformities.

This sits within a broader body of deformity work — including the Active Apex Correction technique for early-onset scoliosis and research into robotic, navigated and 3D-printed patient-specific approaches — through which Dr. Garg has contributed to how complex deformity is corrected internationally.

When to seek a specialist opinion

A specialist deformity assessment is appropriate for severe or rigid curves, sharply angled deformities, deformity that is worsening despite previous treatment, or any deformity associated with leg weakness, numbness, balance problems, or changes in bladder or bowel function. These features warrant prompt review.