Purpose: To compare radiographic and clinical outcomes between dual rod translation (DRT) and traditional rod rotation (RR) techniques in thoracic adolescent idiopathic scoliosis (AIS), with a focus on thoracic kyphosis (TK) restoration.

Methods: This retrospective cohort study included 239 patients with thoracic AIS (Lenke type 1 or 2) who underwent posterior spinal fusion between 2010 and 2024. RR was used as the standard correction technique in earlier cases, whereas DRT was adopted as the primary strategy in more recent cases. Patients were treated with DRT (n = 90) or RR (n = 149). Standing whole-spine radiographs were obtained preoperatively, at 1 week postoperatively, and at final follow-up. Coronal and sagittal alignment parameters were evaluated. Changes from preoperative values were analyzed using mixed-effects models, and intergroup differences were assessed using group-by- time interaction terms. Patient-reported outcomes were assessed using the SRS-22 questionnaire.

Results: Coronal correction of the main thoracic curve was comparable between groups, with both techniques achieving approximately 75% correction at final follow-up. In contrast, sagittal alignment differed significantly between techniques. TK increased by 16° in the DRT group compared with 6° in the RR group (p < 0.001). The DRT group also demonstrated significantly greater improvements in cervical and lumbar lordosis over time. Improvements in SRS-22 domain and subtotal scores at 2 years were comparable between groups.

Conclusions: DRT achieved coronal correction equivalent to RR while providing substantially greater restoration of thoracic kyphosis and more favorable reciprocal sagittal alignment changes. Although short- term patient-reported outcomes were comparable, the enhanced sagittal restoration achieved with DRT may have important implications for long-term spinal and thoracic function in patients with thoracic AIS.