Background The advantages of video assisted thoracoscopic anterior correction for scoliosis are minimal invasion and relatively short-time instrumentation; however the relatively steep leing curve cannot be ignored. Small incision, thoracotomic anterior correction for idiopathic thoracic scoliosis could be another choice because of less demanding technique. We compared the outcomes of these two techniques.Methods Forty-nine patients with idiopathic right thoracic scoliosis were randomly divided into two groups. Group A was 12 girls with mean age 14.9 years, mean Cobb angle 52° and Risser signs +++ to ++++. Ten patients received video assisted thoracoscopic anterior correction with Eclipse rectification and two with Frontier instrumentation. Group B was 4 boys and 33 girls with mean age 14.1 years, mean Cobb angle of 56° and Risser signs ++ to ++++. These patients underwent small incision, thoracotomic anterior instrumentation. The operation time, blood loss, postoperative drainage, instrumented levels, curve correction and eady loss of correction of both groups were analyzed.Results Group A had average operation time of (390+82) minutes, intraoperative blood loss of (600+155) ml, instrumented level of 7.4+1.3, postoperative drainage of (500±160) ml, correction rate of (65±16)% and loss of correction during the 18-36 month followup of (8.6±2.9)%. Group B had average operative time of (220±80) minutes, intraoperative blood loss of (320±120) ml, instrumented level of 7.8±0.9, postoperative drainage of (210±90) ml, curve correction rate of (70±12)% and loss of correction during the 18-36-month followup of (4.6±3.9)%. The curve correction rates of the two groups were not statistically significant (P〉0.05). However, the operative time, blood loss, postoperative drainage, and early loss of correction showed statistical significance (P〈0.05).Conclusion Both video assisted thoracoscopic anterior correction and small incision thoracotomic anterior correction are safe and effective in correcting the idiopathic thoracic scoliosis.