<h3>BACKGROUND CONTEXT</h3> Patients with coronal malalignment with trunk shift toward the convexity of the main coronal curve, and oblique takeoff at the lumbosacral junction, present a unique problem for deformity correction. <h3>PURPOSE</h3> To evaluate fractional curve and coronal malalignment correction, and rate of complications and unplanned revision in Bao Type C patients, compared to Bao Type A and B patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected singlecenter database. <h3>PATIENT SAMPLE</h3> This study included 1039 ASD patients (age: 46 ± 23 y; mFI: .4 ± .7; levels fused: 10.0 ± 4.2). <h3>OUTCOME MEASURES</h3> Outcomes evaluated were coronal alignment and fractional curve correction, and rates of revision surgery at two-year follow-up. <h3>METHODS</h3> A total of 1039 adult spinal deformity patients (age: 46 ± 23 y; mFI: .4 ± .7; levels fused: 10.0 ± 4.2), with minimum five levels fused for thoracolumbar scoliosis were divided into three groups, as proposed by Bao et al: type A: CSVL 3cm and C7 plumb shifted to scoliosis' concavity (n=126); type C: CSVL > 3cm and C7 plumb shifted to scoliosis' convexity (n=30). Outcomes evaluated were coronal alignment and fractional curve correction, and rates of revision surgery at two-year follow-up. <h3>RESULTS</h3> Type C patients more often had fractional curves, and the preoperative magnitude was significantly greater (15.7° Type C, 12.9° Type B, 9.6° Type A, p <0.0001). Of the Type C patients, 50% had pedicle subtraction osteotomy performed, compared with 13.4% Type B, and 13.4% Type A (p <0.0001). Postoperatively, Type C patients continued to have persistently greater fractional curves (7.4° Type C, 6.7° Type B, 5.6° Type A, p=0.026), and worse coronal malalignment (37.8 mm Type C, 34.1 mm Type B, 17.0 mm type A, p<0.0001), though equivalent results with regards to improvement in sagittal alignment, lumbar lordosis, pelvic tilt, and Cobb angle of the major curve. There rate of neurologic complications was higher in the Type C patients, specifically related to TLIF or PSO procedure performed. ALIF procedure in the Type C patients did not confer significant improvement in fractional curve correction, coronal or sagittal alignment correction, or greater lumbar lordosis, compared with TLIF procedure in these patients. There was no difference in the rate of 90-day unplanned readmission or reoperation between the groups. There was no difference in rates of rod fracture or pseudarthrosis at the interbody or PSO site in Type C patients, compared with Type A and B patients. There was no difference in rates or rod fracture, pseudarthrosis, adjacent segment disease, proximal junctional kyphosis, or reoperation for recurrent or persistent malalignment between the two groups at two-year follow-up. <h3>CONCLUSIONS</h3> At two-year follow-up, Type C coronal malalignment patients continue to have worse coronal deformity and fractional curve magnitude compared with Type A and B patients, with no difference, however, in long-term rod fracture, pseudarthrosis or revision surgery rates. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.