Twenty patients with cor pulmonale due to scoliosis and associated spine deformities seen at the Twin Cities Scoliosis Center in the past 20 years have been reviewed. The average age was 37 years. The average scoliosis was 135 degrees and ranged from 90 degrees to 200 degrees. Fifteen patients were placed in halo traction, nine of whom went on to surgical stabilization. Of the nine patients having surgical treatment, five had postpoliomyelitis curves, two had congenital, one had infantile idiopathic, and one had frontometaphyseal dysplasia. The best results were in the postpoliomyelitis group, with an average pretreatment vital capacity of 595 cc and posttreatment vital capacity of 1071 cc; the average PaO2 increased from 55 to 64 mm Hg, and the average PaCO2 decreased from 52 to 43 mm Hg. The only death in the postpoliomyelitis group occurred six years postoperatively. Of the four nonpoliomyelitis patients having surgery, only one survived, the patient with frontometaphyseal dysplasia. The difference between the poliomyelitis and nonpoliomyelitis groups was striking. Patients with cor pulmonale due to spine deformity should have careful evaluation and a trial of halo traction. If the vital capacity improves, the PaO2 increases, and the PaCO2 decreases, then surgical stabilization can often be successfully accomplished. If these parameters do not improve in traction, then surgical treatment can be abandoned.