When a young patient presents with an aggravation of the deformity, surgical treatment is aimed at improving the deformity and stopping further progression of the deformity in the future. The most commonly used surgical procedure is posterior internal fixation with implant fusion. Internal fixations are different multiple instruments including rods, hooks, wires, and screws. These internal fixators are used to maintain the spine in as normal a sequence as possible while the fixation fusion is completed. Internal fixators are rarely removed. A number of factors influence the decision to operate: 1. the part of the spine involved; 2. the severity of the scoliosis; 3. the presence of an aggravating or diminishing kyphosis; 4. the presence of pain (rarely in adolescents, but commonly in adult patients); 5. the presence of continued growth; and 6. personal factors. Second, the considerations of surgery: The purpose of surgery is to fuse the deformed spine at the optimal level of safe orthopedics. With any surgery there are always risks associated with it. In planning your surgical program, the following key points are to be considered: 1. the need for a thorough pre-operative discussion; 2. the use of autologous blood if possible; 3. the need for good nutritional status before and after surgery; 4. an exercise program before and after surgery; and 5. a good frame of mind to deal with the results of surgery.