Neurofibromatosis type-I (NF-I) is an autosomal-dominant hereditary disorder, in which spinal skeletal deformities are one of the manifestations and manifest as acquired abnormalities and present as short, sharp, and angular (usually thoracic) curves. The scoliosis can be severe requiring surgical intervention. The surgical procedure can be difficult because of scalloping of the vertebral bodies and dural ectasia. We state that in selected cases of severe thoracic dystrophic kyphoscoliosis in NF-I, the posterolateral approach is the only possible method to visualize the anterior thoracic spinal cord, perform anterior decompression, and to stabilize the thoracic deformity, because of the anterior dural ectasias and the kyphosis limiting an anterior procedure.