Thirty-four patients underwent surgery for late posttraumatic thoracolumbar kyphosis. Indications for surgery included increasing kyphotic deformity, pain, or increasing neurologic deficit. Procedures included anterior spinal fusion only, posterior spinal fusion only, anterior and posterior fusions as staged procedures, and anterior and posterior fusions under the same anesthetic. Eighteen of the patients with anterior fusions also underwent decompression of the spinal cord by resection of the vertebral body. Stable fusion with halt in progression of deformity was obtained in 33 of the 34 patients by following basic biomechanical principles.