Controversy still exists about the benefits of the anterior approach in comparison with the posterior approach in adolescent idiopathic thoracic scoliois corrective surgery. The aim of this study was to compare the scoliosis correction after the anterior approach with that obtained by the standard posterior procedure in patients with adolescent thoracic idiopathic scoliosis. To compare anterior and posterior approach (and the use of respective instrumentation), a systematic review and meta-analysis of published series of patients with adolescent idiopathic thoracic scoliosis was conducted. The inclusion criteria were as follows: patients with adolescent thoracic idiopathic scoliosis, patients under 20 years at the time of the procedure, articels with only anterior or only posterior instrumentation or their comarison, articels with at least 10 patients included in study, articels with at least 2 years follow up, articels published after 1990 (included 1990), articels in english or german language. Electronic databases (Medline and Scopus) were searched and 69 articels (8 articels analysed only anterior approach, 33 articels only posterior approach, comparasion anterior and posterior approach analysed 9 articels, comparasion of more posterior approaches analysed 19 articels) were included in systematic review and meta-analysis. 13 prospective and 56 retrospective sudies with 4254 patients were analysed. 3560 patients had posterior and 694 had anterior surgery. The evaluations were made according to the parameters employed for evaluating spinal deformities. Meta-analysis with fixed effect and mixed effect for Cobb angle in frontal and sagital plane, rotation of apical vertebra, transposition of apical vertebra, tilt of lowet instrumented vertebra and body disbalans were performed. Anterior approach with respective instrumentation showed better correction in meta-analysis of 4 parameters then posterior approach (Cobb angle in frontal and sagital plane, rotation of apcal vertebra, dsibalans). For 2 parameters meta-analysis results were similar (transposition of apical vertebra, tilt of lowest instrumented vertebra). This meta-analysis showed that anterior approach is more succesfull in 3-D correction of idiopathic thoracic adolescent scoliosis than posterior approch according to some of the analyzed outcome parameter but it is important to stress that differences are small and it is possible to obtain acceptable correction with both approaches.