Systematic review and meta-analysis./r/nThis study aimed to compare the radiographical and clinical outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) in Lenke type 5 adolescence idiopathic scoliosis./r/nPSF has been the standard operation for adolescence idiopathic scoliosis. ASF can also achieve a good curve correction effect with fewer fusion segments and minor invasion of paraspinal structures./r/nA systematic literature research was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Use meta-analysis to compare the changes of thoracolumbar/lumbar and thoracic curves and other important outcomes between ASF and PSF./r/nA total of 427 ASF and 392 PSF patients from 12 studies were included. There was no significant difference in the correction degree of thoracolumbar/lumbar and thoracic curve between ASF and PSF ( P >0.05), except for PSF had more compensatory correction degree of thoracic curve at postoperation ( P <0.05). Besides, the loss of correction in thoracic curve in PSF at the last follow-up was significantly less than that in ASF ( P <0.05). PSF presented larger change values of thoracic kyphosis and lumbar lordosis at the last follow-up ( P <0.05). PSF showed a better effect in correcting trunk shift distance at the postoperation ( P <0.05) but less trunk shift distance correction from postoperation to last follow-up ( P <0.05). There was no significant difference in the incidence of proximal junctional kyphosis and estimated blood loss between the two approaches ( P >0.05). Moreover, ASF showed fewer fusion segments, but longer operation and hospital stay time ( P <0.05)./r/nASF is capable of achieving similar correction in coronal curve and balance as PSF with fewer fusion segments. Spine surgeons should select an appropriate approach tailored to individual patients needs while considering procedural risks and benefits./r/nLevel II.