The concept of the windswept thorax was originally introduced by Dubousset referring to the penetration of the lordoscoliotic apex into the convex hemithorax [8], narrowing the space for lung volume – already narrowed by the rotatory rib deformity – to the most peripheral area between the spine and the chest wall (Fig. 46.1c). In severe cases, the space remaining for convex lung volume is reduced to a narrow sliver as the spine lateral translation into the convex hemithorax squeezes the lung against the chest wall. The term “collapsing parasol” has been used to describe the relative vertical position, or “drooping,” of ribs in primarily hypotonic neuromuscular patients [7], but this description can certainly be applied to the convex rib deformity in any form of EOS (Fig. 46.3a, b). Because the anatomic volume of the hemithorax is so diminished by the combined apical rotation and translation, direct control of this portion of the spine is mandatory if more effective corrective measures to reverse the windswept deformity are to be undertaken. The use of apical pedicle screw anchors, for example, placed only on the convexity to allow further concave growth, permits direct derotation and translation of the apex toward the concave hemithorax (Fig. 46.4a, b). By fusing only the apical segment to stabilize the convex anchors, and then progressively recorrecting the lateral translation toward the concavity by in situ rod contouring at each subsequent scheduled lengthening, the goal of controlling – indeed improving – deformity while permitting or driving growth, fundamental to the management of EOS, can be achieved [10]. The procedure described here combines progressive apical correction with serial lengthening – the best effects of traditional GRI and the growth-guidance concepts.