69+11-year-old female with a degenerative scoliosis that produced an increasing truncal imbalance to the right, and a thoracic kyphosis that was progressing as well. She underwent a posterior realignment from the upper thoracic spine to the sacrum and ilium with a second stage anterior fusion/cage procedure. At 5 years postoperative, she has maintained excellent coronal and sagittal alignment and balance as well as function.