Complete staghorn calculi present one of the most challenging conditions in managing upper urinary tract stones. The complexity of treatment increases significantly when combined with severe scoliosis, particularly in patients with a Cobb angle exceeding 90°. This case report describes the treatment of a patient with severe scoliosis, characterized by a Cobb angle greater than 90°, who also presented with complete staghorn calculi. The patient successfully underwent single-stage, totally ultrasound-guided, tubeless mini-percutaneous nephrolithotomy, achieving excellent stone clearance without complications. This report aims to enhance the understanding of diagnosing and managing severe scoliosis in patients with complete staghorn calculi and to highlight the efficacy and safety of totally ultrasound-guided mini-percutaneous nephrolithotomy as a surgical approach.