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Study Design A retrospective case study was performed on the single-stage posterior transvertebral closing-wedge osteotomy for treatment of adult thoracolumbar kyphosis. Summary of Background Data Forty-one consecutive cases in 38 patients available for follow-up, averaging 33 months (range 4–87 months), are included. All patients had severe pain and/or deformity; 51% of cases had previous fractures, and 49% had postlaminectomy failed back syndromes with kyphosis. A preoperative neurologic deficit was present in 34% of the cases including two with cauda equina syndrome. Methods Patient examination and interviews, subjective questionnaire, chart reviews, and radiographic measurements were performed independently. Complications, risks, benefits, results, and biomechanical considerations were evaluated and discussed as compared with other techniques. Results All cases had solid union at follow-up; 93% maintained correction averaging 35° with three requiring revision for failure. Postoperatively, 19.5% of the cases had new neurologic deficits with five (12.2%) temporary or minor and three (7.3%) major, including one with unimproved paraplegia at follow-up. Eight of the 14 preoperative neurologic deficit cases improved postoperatively; 26 additional surgeries were performed on 18 patients most commonly for pain (x11) and additional trauma (x4). The subjective questionnaire results indicated significant patient satisfaction, with 76% stating they would repeat the surgery and 90% recommending it to another. Conclusion This technically demanding high-risk procedure provides an effective and mechanically superior correction for acute angle thoracolumbar kyphosis in selected adult patients, with high subjective satisfaction.