A 16-year-old female presented with progressive adolescent idiopathic scoliosis. Her curve had increased from 40 degrees to 46 degrees over two years while wearing a brace. Pre-op x-rays showed a 46 degree thoracic curve. The indications for surgery were a progressive curve, pain, and deformity. The surgical strategy involved segmental spinal instrumentation from T2 to L1 using pedicle screws, multiple osteotomies from T5 to T10 including Smith-Peterson osteotomies, and posterior spinal fusion from T3 to L1. Post-op films showed the patient was well-balanced in the coronal and sagittal planes, and her symptoms resolved following surgery.