However, aggressive correction of a rigid deformity is not necessarily appropriate for every patient—particularly when the spinal cord is already compromised. In this case, a posterior internal gibbectomy with posterior instrumentation was performed using a posterior VCR-type approach. Bilateral transpedicular decancellation created sufficient space to carefully push the internal gibbus anteriorly and decompress the spinal cord without rib excision or aggressive correction of the deformity. The patient noticed improvement in leg heaviness within 48 hours and started mobilizing with an improved gait. An Old Principle with a Selective Modern Role Internal gibbectomy remains relevant in carefully selected cases of healed spinal tuberculosis with severe angular kyphosis and late-onset neurological deterioration. Modern spine surgery is not simply about achieving maximum deformity correction. The surgical strategy should be individualized according to the pathology, neurological status, and risk to the spinal cord. Sometimes the best correction is not maximum correction but the safest possible decompression. Dr. Pramod Saini, Orthopaedic Spine Surgeon, Noida