Fifteen patients with congenital scoliosis due to segmented hemivertebra were treated by combined anterior and posterior fusion (four cases), short (two level) convex fusion (five cases), and extended (four-level) convex fusion (six cases). Age at operation averaged 3 years 3 months. Follow-up averaged 10 years. All patients treated by the combined approach were improved; all patients treated by long posterior fusion were either stabilized or improved. Short posterior fusion resulted in failure in all patients treated by this technique. Congenital scoliosis preferably should be treated by an early combined approach. Posterior convex fusion should be limited to patients in whom an anterior approach is technically unfeasible. Posterior fusion in these cases should be extended to four levels: two distal and two proximal to the hemivertebra.