Prospective clinical study. To evaluate pulmonary function tests at a minimum 2-year follow-up in patients with adolescent idiopathic scoliosis (AIS) undergoing either an endoscopic versus open anterior fusion along with posterior segmental fixation and fusion. A total of 21 patients with AIS underwent a video-assisted thoracoscopic (VAT group) release/fusion followed by a posterior spinal fusion (PSF) and segmental spinal fixation were compared to 16 patients who underwent an open thoracotomy (Open group) followed by a PSF. The mean preoperative thoracic Cobb was 70 degrees in the VAT group versus 75 degrees in the Open group. All patients had preoperative and a minimum 2-year postoperative pulmonary function tests consisting of forced vital capacity (FVC) forced expiratory volume in one second (FEV-1). The average thoracic Cobb correction was to 27 degrees (61%) in the VAT group versus 36 degrees (52%) in the Open group. Preoperative and 2-year postoperative FVC in the VAT group averaged 2.48 L and 2.85 L, respectively (P = 0.006). The Open group corresponding results were 1.97 L and 2.43 L, respectively (P = 0.001). Preoperative and minimum 2-year postoperative FEV-1 in the VAT group averaged 2.06 L and 2.37 L, respectively (P = 0.005). Values for the Open group were 1.65 L and 2.08 L, respectively (P = 0.001). Although both groups had pulmonary function test parameters that were statistically improved postoperative versus preoperative, there were no significant differences comparing the VAT group to the Open group (P > 0.05) VAT versus Open release/anterior fusion in association with a PSF for select AIS curves requiring circumferential treatment both demonstrated similar radiographic and pulmonary function test improvement at 2 years postoperative, with no significant differences seen between the groups.