Certain severe cases of scoliosis cannot be controlled by anterior or posterior spinal fusion alone. In these cases, a combined same-day anterior / posterior surgery is performed. New blood-conserving techniques of surgery have been developed, allowing the surgeon to complete both surgeries under the same anesthesia. The chief advance is that of the argon beam coagulator, which gently coagulates bleeding tissue with an electron stream.

The following case presents two technical challenges. First, the patient has a severe scoliosis with her trunk shifted to the right. Second, it is desirable not to fuse below L3, preserving the lumbar motion segments. To meet these requirements, the first stage of surgery is anterior release and spinal fusion with instrumentation. Anterior surgery allows powerful correction to re-center L3 over the sacrum. The fusion can be stopped at L3 if the thoracolumbar scoliosis is fully corrected.

The second stage posterior spinal fusion and instrumentation allows correction of the upper thoracic curve and provides additional fixation to maintain the full correction of the lumbar curve without bracing.