A retrospective review was performed to investigate patterns of spinal deformity associated with neurofibromatosis and the incidence of pseudarthrosis and curve progression after spinal fusion. Twenty-three of the 32 patients (72%) with spinal deformity had dystrophic curve patterns. The incidence of pseudarthrosis was 38% for the dystrophic group undergoing isolated posterior fusion. Their average curve progression was 12.7 degrees and required an average of 1.7 procedures to achieve solid posterior fusion. Kyphoscoliotic curves should be treated with combined anterior/posterior fusion.