Introduction: The management of severe and rigid spinal deformities remains one of the greatest challenges in spine surgery. Posterior vertebral column resection (PVCR) has evolved into a powerful technique that allows three‑column correction through a single posterior approach. Despite its technical demands and potential complications, PVCR offers the possibility of meaningful correction and functional improvement in carefully selected patients.

Material and Method: This prospective case series included 31 patients with severe (Cobb angle >60°) or rigid kyphotic deformities who underwent single‑stage PVCR between July 2016 and June 2023. Demographic data, operative parameters, radiological correction, functional outcomes, and complications were analyzed. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for pain.

Results: The mean age of patients was 30.7 ± 9.8 years (range 15–52), with a mean follow‑up of 27.6 ± 8.4 months. The average operative time was 422 ± 95 minutes (range 320–760), and mean intraoperative blood loss was 760 ± 210 mL (range 560–1380). Postoperative kyphotic Cobb angle correction ranged from 31.2° to 56.4°, representing substantial deformity reduction. Functional outcomes improved significantly: mean ODI decreased from 58.6 ± 6.5 preoperatively to 11.2 ± 3.5 at final follow‑up, and mean VAS improved from 6.7 ± 0.5 to 1.8 ± 0.7. Complications included dural tears in 3 patients (9.6%), transient thoracic root pain in 1 patient (3.2%), and neurological deterioration in 4 patients (12.9%)—three of which were transient with full recovery within 3 months, and one late‑onset deficit with partial recovery. Surgical site infection occurred in 1 patient (3.2%). No mortality was observed.

Conclusion: Single‑stage PVCR is a safe and effective option for the correction of severe and rigid spinal deformities when performed in experienced hands. Despite its complexity and potential complications, PVCR can achieve substantial radiological correction, significant pain reduction, and marked functional improvement, making it a valuable tool in the armamentarium of deformity surgery.