Background: Surgical correction and reduction of osteotomy site in complex rigid kyphoscoliosis remains a formidable challenge, the use of domino assisted dual rod cantilever correction in patients with rigid kyphoscoliosis has not been specifically studied.

Methods: Between January 2018 and December 2022, data from consecutive cases involving 25 patients who underwent posterior-only approach, dual-rod cantilever correction with domino connectors for osteotomy reduction, and anterior column support using cages with a minimum follow-up of 2 years were obtained. All surgical procedures were performed by the same author. Radiographic parameters were assessed preoperatively and postoperatively. Complications were documented.

Results: Patients had a mean age of 19 years, Male: female ratio was 14:11. Etiology of 25 kyphoscoliosis were congenital (18), Dystrophic (5), Neuromuscular

(1) and Idiopathic (1). Preoperative major curve Cobb angles (99.30° ± 9.24°) improved significantly to 56.4°

± 8.94° at final follow-up (mean correction: 42.9°, 43.13%; p<0.001). Similarly, kyphotic angles decreased significantly from 103.15° ± 20.28° to 62.10° ± 14.92° (mean correction: 41.05°; p<0.001). Significant improvements were observed in sagittal vertical axis (p<0.001), and coronal balance (p<0.001). Four complications were documented: one dural tear, two transient neurological deficits, and one asymptomatic rod breakage. No pseudarthrosis or infections were recorded.

Conclusion: Dual-rod cantilever correction with domino connectors is effective for the reduction of osteotomy site and deformity correction achieving satisfactory radiological outcome with acceptable complication rates.