Because the pedicle screw system does not have a long history of use, few studies have reported on its long-term clinical outcomes.Min et al. reported a correction rate of 55% after PS internal fixation in 48 patients with Lekes type 1 and 2 adolescent idiopathic scoliosis. The follow-up of this group of patients was 10 years.SKK et al. reported an overall correction rate of 69% in 203 patients with King types 2, 3, 4, and 5. Several studies have claimed that there is a tendency for the posterior thoracic kyphosis angle to decrease after PS internal fixation. However, Min et al. and Suk et al. found that the posterior thoracic kyphosis angle does not decrease after PS internal fixation, but rather increases, averaging up to 5°. The postoperative fusion rate was 100% in both studies. The functional clinical outcome (SRS-24 questionnaire, maximum score of 120) at 10-year postoperative follow-up was (95+22).The reoperation rate in the study by Min et al. was 12.5% (6 patients underwent implant removal due to SSI).Suk et al., on the other hand, found that in the early postoperative period, the incidence of SSIs was 1.5%, and 1 of these patients required removal of the implant. Despite the occurrence of SSI, these patients achieved solid osseointegration at the final follow-up. None of the patients in this two-person study required reoperation due to junction zone or neurologic complications. However, due to the high rate of correction of scoliosis deformities with the all-PS internal fixation system, reports related to shoulder imbalance after PS internal fixation have begun to appear in recent years. There are 2 solutions to this problem: (1) the upper immobilized vertebrae (UIVs) should include T2; and (2) the correction rate should be reduced in patients with right thoracic curvature so as not to elevate the left shoulder. It has been reported in the literature that after spinal fusion in patients with adolescent idiopathic scoliosis, the incidence of junctional lesions in patients treated with a total PS internal fixation system was not significantly different from that in patients treated with a hybrid internal fixation system, even though the total pedicle screw internal fixation system was biomechanically more rigid than the latter. Another study found a correlation between preoperative proximal UIV kyphosis and its postoperative progression in patients with adolescent idiopathic scoliosis treated with spinal fusion. The progression of junctional lesions after spinal fusion for adolescent idiopathic scoliosis may be a multifactorial event, and further studies are needed to draw conclusions.