Ankylosing spondylitis and old spinal tuberculosis often lead to kyphosis. The former is a rounded kyphosis, which is usually not accompanied by spinal cord compression symptoms, while the latter is an angular kyphosis, which is often accompanied by spinal cord compression symptoms. Spinal tuberculosis is a common disease in our department, so we often encounter patients with old spinal tuberculosis kyphosis, which is angular kyphosis and is suitable for total vertebrectomy and orthopedic surgery (VCR). With the continuous development of total vertebrectomy orthopedic technique for treatment of old spinal tuberculosis kyphosis in our department, we have also treated many patients with ankylosing spondylitis kyphosis, who are suitable for transforaminal osteotomy (PSO). Patients with severe ankylosing spondylitis have a kyphosis angle greater than 70 degrees, cannot lie down, have difficulty walking, and those with cervical spine ankylosis are unable to look down, which seriously affects the patients’ quality of life. Using single vertebra transpedicular osteotomy to treat patients with severe kyphosis, it is difficult to get good orthopedic effect and cannot restore the sagittal balance of the spine, only using double vertebra osteotomy can get satisfactory results, but double vertebra osteotomy has higher technical requirements and surgical risks than single vertebra osteotomy. The following are two typical cases. Case 1: A 33-year-old male patient was admitted to the hospital with a back kyphosis deformity of 18 years, aggravated for 3 years. On examination, severe kyphosis was seen, and both hips were flexed at 20° deformity. The patient could not sleep flat and had difficulty walking. Preoperative radiographs showed a maximum kyphosis angle of 101° in the whole spine and old fracture dislocations in lumbar 3 and 4. We performed a transpedicular osteotomy of lumbar 1 and 3, which went smoothly, and the patient’s maximum kyphosis angle was 41°, corrected by 60°, with a correction rate of 60%. The patient was able to walk and sleep upright again. Case 2: A 27-year-old male patient was admitted to the hospital with low back pain with kyphosis for 2 years. On examination, severe kyphosis was seen. The patient was unable to sleep and had difficulty walking. Preoperative radiographs showed a maximum lordosis angle of 80° for the whole spine. We performed a transpedicular osteotomy of lumbar 1 and 3, which went smoothly, and the maximum kyphosis angle of the whole spine was 4°, which was corrected by 76°, with a correction rate of 95%. The patient was able to walk and sleep upright again.