Congenital kyphosis and kyphoscoliosis are much less common than congenital scoliosis but potentially more serious, because these curves can progress rapidly and Type I deformities can lead to spinal cord compression and paraplegia. No one operative procedure can be applied to all types and sizes of deformity. The method of surgical treatment depends on the age of the patient, the type and size of the deformity, and the presence or absence of spinal cord compression causing a neurologic deficit. All patients with a Type I or Type III congenital kyphosis or kyphoscoliosis should be treated by a posterior arthrodesis before the age of 5 years and before the kyphosis exceeds 50°. A kyphosis that does not reduce to less than 50° as measured on the lateral spine radiograph made with the patient supine requires an anterior release and arthrodesis with strut grafting followed by posterior arthrodesis with instrumentation (if possible)