[Objective] To introduce the surgical technique and primary clinical outcomes of spinal canal decompression of the adjacent segment and posterior three-column osteotomy to treat severe post-tubercular kyphosis with adjacent segmental spinal stenosis. [Methods] Between January 2012 and December 2017, 9 patients with severe post-tubercular kyphosis were included. Spinal canal decompression of the adjacent segment and posterior three-column osteotomy was applied to improve spinal cord compression and correct the deformity. Posterior vertebral column resection was applied in 8 cases, and transpedicular wedge resection osteotomy was applied in one case. [Results] Two cases had neurological injuries, including one with complete paraplegia and one with incomplete paraplegia. Other 7 cases were of improved neurological status after surgery. The mean postoperative ODI scores, VAS scores and kyphotic angles were significantly improved compared with preoperative data. Fusion of the osteotomy sites was achieved in each patient at follow-up. [Conclusions] Spinal canal decompression of the adjacent segment and posterior three-column osteotomy can correct severe post-tubercular kyphosis with adjacent segmental spinal stenosis.