Thirty-four consecutive patients with congenital kyphosis treated surgically between 1971 and 1979 at Boston Children's Hospital were reviewed. Cases were classified into 25 Type I (failure of formation), seven Type II (failure of anterior segmentation), and two Type III (mixed). Staged anterior decompression and posterior fusion was the treatment in 15 Type I cases. Five Type II cases underwent posterior fusion. Patients ambulated in a body cast postoperatively for six months. Neurologic deficit improved postoperatively in six of eight cases. Pseudarthrosis occurred in two of 27 cases (7%) followed for one year. Early surgical treatment of Type I deformity is recommended. Anterior decompression is essential with neurologic deficit. Anterior and posterior fusion are recommended when kyphosis is greater than 60 degrees.