The spatial relations between the aorta and vertebrae are changing with posture, surgical techniques, and operative maneuvers. “Risky screws” (within 1–3 mm proximity to the aorta or other adjacent tissues) were found in 5.8–15.2 % screws. In order to avoid early and later aortic complications secondary to scoliotic operations, careful preoperative metrology of aorto-vertebrae relations is of crucial importance. Compared with patients with idiopathic scoliosis, Marfan-related scoliosis is characterized by faster progression and it is more bracing-resistant due to the particular developmental anomalies in Marfan syndrome, implying the refractory nature of the latter. The present study aims to highlight the clinical impact of preoperative aorto-vertebra metrology in the scoliotic operations.