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Severe Scheuermann’s kyphosis can be associated with pain and a lifetime of progression. Operative treatment in carefully selected patients has been shown to improve radiographic outcomes, pain, and satisfaction compared to non-operative treatment. Historically, combined anterior disc releases and fusion with posterior instrumentation and fusion was the preferred method of treatment. However, more recently with improvements in spinal instrumentation and use of posterior osteotomies anterior surgery is rarely indicated. This paper outlines the process of a posterior spinal fusion with posterior column osteotomies for Scheuermann’s kyphosis.