Severe neglected congenital scoliosis with tethered cord presents major difficulties in management. The primary objective of this study was to identify the risk factors associated with corrective scoliosis surgery in neglected cases presenting with severe deformity. Six patients who presented with such problems draw attention to the importance of a staged anterior and posterior approach in order to obtain satisfactory functional results. However, corrective surgery is associated with major neurologic and systemic complications, and every effort should be made to intervene with the progression of the deformity before corrective measures becomes necessary.