57 year old healthy woman, with a non-symptomatic aortic aneurysma after a traffic accident 30 years ago and a 70:ty degree thoracolumbar kyfo-scoliosis, was referred for treatment because of severe postural back-pain. The anticipated treatment was correction of spinal balance with an apical osteotomy, a long instrumentation and maximal number of atachments. A careful preoperative investigation, including DEXA, bending films, internal medical judgement and