Chest wall tumors often require en bloc resection, including resection of one or more ribs. Following rib resection, there can be a biomechanical imbalance in the lateral forces exerted on the two sides of the spine with a resultant net force on the spinal column, leading to postoperative scoliosis, also known as thoracogenic scoliosis. Most commonly seen in children following lateral thoracotomy, thoracogenic scoliosis can occur with the convexity ipsilateral or contralateral to the thoracotomy. Thoracogenic scoliosis is progressive, and risk factors include younger age, thoracotomy during periods of peak growth, and resection of three or more ribs. In children, upfront instrumentation is generally avoided due to growth concerns and difficulty placing conventional instrumentation given the smaller anatomy. However, intervention is often required when there is progressive deformity, and growth-permissive techniques such as growing rods and the vertical expandable prosthetic titanium rib (VEPTR) are preferred. Definitive fusion can then be performed at skeletal maturity. In adults, thoracogenic scoliosis is relatively uncommon as there is no continued growth of the spinal column, and patients in whom there is concern for spinal instability postresection can be instrumented at the time of resection. In both children and adults, there is an interplay between preservation of motion segments and achieving optimal deformity correction. In this chapter, we discuss the proposed pathology and risk factors for thoracogenic scoliosis as well as the management of this deformity in pediatric and adult patients.