A 13-year old female patient with rigid neglected congenital thoracolumbar scoliosis of 128 degrees presented with severe coronal decompensation [the head was not centered over the pelvis despite spontaneous compensatory corrections within the spine].
MRI revealed a split spinal cord without any obvious septum with equivocal evidence of cord tethering. Heroic correction in the setting of intraspinal anomaly can lead to a neurological catastrophe. In view of this, only mild distraction force was applied over anchor points at the end of the curve, the main aim being to restore the coronal plane balance. The same was successfully achieved with a resultant 38% correction of the deformity, giving an overall satisfactory cosmetic correction. Since the crooked spine was straightened up, the child also gained a significant height after the surgery!