At present, with the maturation of spinal pedicle screw application technology and posterior osteotomy technology, the orthopedic effect of severe spinal deformity has been significantly improved, with a correction rate of 55%-69%. However, because of the high surgical risk, trauma, and patient tolerance requirements associated with the surgical treatment of severe spinal deformities, postoperative complications such as screw misplacement, nerve injury due to compression and pulling of the osteotomy ends together, and broken nails and rods can occur. Therefore, how to effectively reduce postoperative complications, and how to diagnose and manage them in a timely manner is of great clinical significance, but little has been reported so far. From September 2006 to May 2013, 147 patients with severe spinal deformity were treated by one-stage posterior osteotomy orthopedic surgery at Zhengzhou University First Affiliated Hospital, Li Ning, and 17 of them had postoperative complications. In this paper, we retrospectively analyzed the data of patients with complications with the aims of (1) summarizing the complications that occurred after the treatment of severe spinal deformity by one-stage posterior osteotomy orthopedic surgery, and (2) To investigate the causes of postoperative complications and their management. All patients in this group were followed up for 1-6 years, with an average of 3.5 years. 147 patients had a postoperative scoliosis Cobb angle of 8° to 92°, with a correction rate of 45% to 74% (postoperative Cobb angle/preoperative Cobb angle); and a posterior convex Cobb angle of 6° to 63°, with a correction rate of 51% to 64% (postoperative Cobb angle/preoperative Cobb angle). 17 cases had complications, with an incidence of 11.6% (postoperative Cobb angle/preoperative Cobb angle). The incidence was 11.6% (17/147). Seven cases in this group showed sensory and muscle strength changes in the lower extremities, including two cases changing from preoperative ASIA grade D to postoperative grade C, five cases changing from preoperative ASIA grade E to grade C in two cases and grade D in three cases. Among the 147 patients with severe spinal deformity, 7 cases had postoperative neurological complications, the incidence of which was 4.8%. 2 patients had skin breakdown and infection due to inappropriate bracing and involvement of internal fixation, and the infection was not cured despite repeated debridement, and the internal fixation was removed and the wound healed after surgery because the CT scan showed that the bone graft had fused. 3 patients had postoperative rod breakage and cap loss, 1 of which was due to high energy In three cases, the fixation rods were broken due to high energy trauma, and in two cases, the nail caps were dislodged due to improper placement of the pedicle nail system and premature postoperative spinal weight-bearing. five patients had postoperative abdominal pain and abdominal distension, which were considered to be related to the development of superior mesenteric artery syndrome and were gradually relieved after 3-8 d of symptomatic treatment, including rehydration, analgesia, gastrointestinal decompression, and nasal feeding. In conclusion, posterior osteotomy and orthopedic internal fixation of the spine is an effective treatment for severe spinal deformity, but posterior osteotomy and orthopedic surgery in the first stage of severe spinal deformity is a difficult procedure, and neurological complications such as pedicle screw placement into the spinal canal, nerve injury by closing and pulling the osteotomy end, nerve compression by residual bone at the osteotomy, acute spinal cord injury, and complications such as broken rod, decapitation, and superior mesenteric artery syndrome may occur. The treatment measures for complications are to improve the accuracy of pedicle screw placement, the number and position of screws should be reasonable, the pulling pressure at the osteotomy end should be moderate, the bone block at the osteotomy end should be completely occluded, the postoperative sensory-motor changes of the limb should be closely observed, the neurological pressure-causing factors should be removed by timely surgical investigation, hormonal shock and neurotrophic drugs should be given, and appropriate supports should be worn in the early postoperative period to avoid violent impact on the surgical site.