Posterior three-column spinal osteotomies, including vertebral column resection and pedicle subtraction osteotomy, are effective for correcting severe adult spinal deformity. After the surgery, optimal curve correction, solid fusion and ideal sagittal spinal restoration can be achieved. However, some complications may be encountered during the follow-up period, including rod breakage, proximal junctional kyphosis and proximal junctional failure, pull-out and failure of distal ifxation. In attempt to address the above complications, several recent studies have introduced some proper surgical methods in patients with adult spinal deformity following three-column osteotomy, including satellite rod technique, cement augmentation at proximal junctional areas, multilevel stabilization screw technique, and second sacral ala-iliac technique. With these techniques, incidence of postoperative complications has been dramatically decreased.