Introduction: The treatment of severe spinal deformities is a demanding and difficult surgical task. Angular osteotomies such as Ponte, Smith Peterson, and Pedicle subtraction osteotomy may not provide the desired amount of correction in very severe deformities with coronal or sagittal plane decompensation.

Objective: To evaluate the outcome of single stage vertebral column resection (VCR) and reconstruction for three column correction in kypho-scoliotic deformity due to hemivertebrae.

Materials & Methods: This prospective interventional study which includes 20 cases of kypho-scoliotic deformity, was carried out from March 2017 to December 2024. Single stage VCR and reconstruction were performed in all these patients. Pre & Post-operatively, neurological assessment was done by the modified Nurick grading system, Scoliosis Research Society-22 and spinal appearance questionnaires. Scoliosis and kyphosis angle were measured by Cobb’s angle measurement method. Pain control was assessed by VAS Score & overall functional assessment by modified Odom’s score.

Results: Average age of the patients was 22 years (range 9-35). Within the study population, 13 patients presented with preoperative gait disturbances. Among them 10 improved to normal gait, 2 remained the same and 1 showed deterioration to non-ambulatory level. Total SRS-22 scores improved from 3.18 to 3.54 (p5.01), primarily self-image domain. The average kyphotic correction was 15±3.25 ͦand scoliosis correction was 36±14.19 ͦ. Overall, 54% patients had excellent, 28% had good, 10% had fair and 8% had poor outcome.

Conclusion: Posterior vertebral column resection is the most powerful posterior osteotomy method providing a successful correction of fixed complex deformities. From our study, it is evident that single stage VCR can be an effective option to manage severe rigid spinal deformities.