Spinal deformities occur in relation to several pathologies, but prevalence continues to increase as the population ages resulting in a significant impact on health-related quality of life and disability. The goals of deformity correction surgery are to improve pain or neurologic deficits when they exist, improve health-related quality of life, and to correct the existing deformity while preventing deformity recurrence or progression. Rigid deformities often need osteotomies for correction. Osteotomies are most widely classified by the Schwab classification ranging from 1 to 6 in increasing order of the amount of bone removed. Posterior column osteotomies are used in more mild deformities with mobile discs to correct sagittal imbalance. Pedicle subtraction osteotomies are three-column osteotomies that can be used for more severe sagittal imbalance without mobile discs and in the presence of previous spinal fusion. Vertebral column resections involve removing the entire vertebra and are used in severe combined coronal and sagittal deformities and are the most invasive. The choice of osteotomy is dependent on the type of and severity of deformity and patient factors weighing potential risks and obtaining the desired correction.