Objective: To evaluate the efficacy and safety of standard percutaneous nephrolithotomy(PCNL)for patients with deformity of spine.Methods: Between August 2003 and May 2012,76 patients of upper urinary tract calculi with scoliosis and kyphosis had undergone PCNL accessed by two steps dilation to 24 F tract with ultrasound guidance.Clinical data were analyzed retrospectively.Results: The percutaneous renal access was successfully established in 76 patients under ultrasound guidance and immediate lithotripsy was performed.Prone position 14 units,lateral position 21 units,and other unconventional position 49 units,84 units totally.Sixty-eight(80.9%)units were operated by single access and 16(19.1%)by double in one session.The mean first accessing time was(7.9±4.8)min,and stone management time was(46.2±31.6)min.The stone-free rate after the first operation was 83.8%,eight kidneys accepted another PCNL to remove the residual calculi,and the last stone-free rate was 89.5%.Five cases needed transfusion.No injury of adjacent organs or urosepsis occurred.No severe complications occurred.Conclusions: Standard PCNL for calculi in patients with deformity of spine accessed by two steps dilation to 24 F tract with ultrasound-guided puncture could be effective and safe.Dividual operative position and experienced clinical technique are needed.