PurposeWhile posterior spinal instrumentation and fusion (PSIF) for severe adolescent idiopathic scoliosis (AIS) is the gold standard, anterior vertebral body tethering (AVBT) is becoming an alternative for select cases. Several studies have compared technical outcomes for these two procedures, but no studies have compared post-operative pain and recovery.MethodsIn this prospective cohort, we evaluated patients who underwent AVBT or PSIF for AIS for a period of 6 weeks after operation. Pre-operative curve data were obtained from the medical record. Post-operative pain and recovery were evaluated with pain scores, pain confidence scores, PROMIS scores for pain behavior, interference, and mobility, and functional milestones of opiate use, independence in activities of daily living (ADLs), and sleeping.ResultsThe cohort included 9 patients who underwent AVBT and 22 who underwent PSIF, with a mean age of 13.7 years, 90% girls, and 77.4% white. The AVBT patients were younger (p= 0.03) and had fewer instrumented levels (p= 0.03). Results were significant for decreased pain scores at 2 and 6 weeks after operation (p= 0.004, and 0.030), decreased PROMIS pain behavior at all time points (p= 0.024, 0.049, and 0.001), decreased pain interference at 2 and 6 weeks post-operative (p= 0.012 and 0.009), increased PROMIS mobility scores at all time points (p= 0.036, 0.038, and 0.018), and faster time to functional milestones of weaning opiates, independence in ADLs, and sleep (p= 0.024, 0.049, and 0.001).ConclusionIn this prospective cohort study, the early recovery period following AVBT for AIS is characterized by less pain, increased mobility, and faster recovery of functional milestones, compared with PSIF.Level of evidenceIV.