BACKGROUND AND PURPOSE: To assess the feasibility and efficacy of percutaneous nephrolithotomy (PCNL) in patient with spinal deformities. PATIENTS AND METHODS: A 70 years old severe kyphotic male presented with left renal and bladder calculus. He was cardiorespiratory compromised. Under local anaesthesia and propped up position bladder stone was removed with flexile cystoscope . Ureteric catheter was passed in the left pelvicalyceal system. For PCNL neither prone nor supine position was possible, so patient was turned to right lateral position and under local anaesthesia USG guided access was made and stone completely cleared. No DJ stent was kept as removal would require flexible cystoscopy. Nephrostomy was removed on 2nd postoperative day. RESULTS- Patient tolerated the procedure well. Only two doses of analgesic required in postoperative period. There was no complication and hemoglobin drop was 0.5 mg %.Patient was discharged on 3rd postoperative day in satisfactory condition. CONCLUSION: PCNL in sever spinal deformity require proper preoperative planning and procedure is safe in experienced hand