Revision surgery is often unavoidable when there is a problem with the internal fixation structure. Possible problems include subcutaneous bulging of the implant, displacement, and fracture of the prosthetic joint with or without the implant. Subcutaneous bulging of the implant almost always occurs in thin patients with inadequate correction of deformity in the parietal region, with the convex side of the parietal thoracic curve being the preferred site. The use of unidirectional nails or low-cut implants may reduce the incidence of such complications. Implant protrusion due to proximal or distal implant extraction or displacement is a common cause of revision of the upper and lower end of internal fixation. These complications are more common in patients with posterior or lateral kyphosis, especially when the internal fixation structure is too short at the upper or lower end or when the head and tail anchorage is not ideally stabilized after substantial orthopaedic adjustment. Revision surgery in these patients is difficult because the old implant tends to destroy or erode the adjacent bone structure, and even if this were possible, revision surgery in these segments would be quite difficult. In such cases, it is often necessary to extend the internal fixation several segments up and down. In addition, primary spinal deformities require correction using spinal osteotomy techniques, including total spondylotomy, to prevent recurrence of similar implant complications. Typically, halo-gravitytraction (HGT) prior to revision surgery helps to correct the proximal thoracic or cervicothoracic segment kyphosis. A 15-year-old female patient with multiple neurofibromas is shown. She has a long history of lateral thoracic segment kyphosis and has undergone two anterior and five posterior internal spinal fusion procedures, ranging from in situ fusion fixation as a child to final posterior implant removal due to implant protrusion and progression of the deformity. She ended up with a lateral convexity of 110 and a posterior convexity of 160°. Her 3D CT and MRI showed severe deformity due to the deformity, with her spinal cord bulging in compression at the parietal vertebrae of the kyphosis. After several weeks of traction, she underwent a 3-segment VCR and a posterior internal fixation fusion of C7-L3.