Thirty-six adolescents with idiopathic scoliosis were randomized to receive either direct vertebral rotation (DVR) (n=18) or simple rod derotation (SRD) (n=18). The primary outcome of interest was the correction of apical vertebral rotation, measured using CT scans. Secondary outcomes included Cobb angle correction, rib hump correction, shoulder height difference, and patient-reported outcomes via the Scoliosis Research Society (SRS-22) questionnaire. Outcomes were assessed preoperatively, immediately postoperatively, and at a 2-year follow-up. Overall, the study revealed that both techniques significantly improved apical vertebral rotation, but DVR demonstrated superior correction and a greater reduction in rib hump angle. However, no significant differences were found between groups in terms of Cobb angle correction or shoulder height difference. The findings suggest that DVR provides better rotational correction, which may lead to improved cosmetic outcomes.