Introduction: Recent advances in spinal instruments allow us to address nearly all components of idiopathic scoliosis. Direct vertebral rotation (DVR) maneuver was introduced to correct apical axial vertebral rotation. It is however still not well established how efficiently DVR affects results of scoliosis correction. The object of the study was to evaluate en bloc apical vertebral rotation (DVR) and its impact on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis treatment. Patients and Methods: This is a Prospective Randomized Control Clinical trial study from 2018 till 2020, with a follow-up range from one year to 2 years performed in the Department of Neurosurgery, Zagazig University hospitals in Egypt with IRB approval number (ZU-IRB#4375/25-2-2018). Forty consecutive patients with adolescent idiopathic scoliosis who underwent a posterior spinal fusion with pedicle screws only construct (treated with posterior only approach) were the material of this study. They were divided into two groups: First group: Twenty patients were corrected by rod rotation and direct vertebral rotation. Second group: Twenty patients were treated with rod rotation only. These patients were reviewed regarding radiographic and photogrammetric parameters pre and immediately postoperative and 1-year post-operative. Radiological parameters included proximal thoracic, main thoracic and thoracolumbar/lumbar cobb angle, global coronal balance GCB, global sagittal balance GSB, clavicle first rib intersection difference C1RID, T1 tilt, apical vertebral translation AVT, thoracic kyphosis TK(T5-12), lumbar lordosis LL(L1-S1), Rib hump difference RH diff, rotational, apical sagittal angle RAsag on ct scan was measured according to Aaro and Dahlborn, SRS 22 questionnaire. Cosmetic parameters included Shoulder height angle (SHA), Axilla height angle (AHA), Waist height angle (WHA), and Angle of trunk rotation (ATR). The primary endpoint of the study was to determine the efficacy of DVR on thoracic kyphosis formation, axial rotation, global sagittal and coronal balance and the best Lenke curve to be treated with DVR. Secondary endpoints included: 1- Correlation between clinical photogrammetric measurements and degree of Cobb angle correction. 2- Definition of the radiological parameters that best correlate with clinical shoulder parameters The following radiographic parameters (C1RID, T1 tilt, and Rasag) were studied regarding its correlation with the clinical SHA and AHA both pre and post-operatively 3- Definition of the radiological parameters that best correlate with clinical rib hump parameters The following radiographic parameters (Rh diff, and Rasag) were studied regarding their correlation with the clinical ATR, AHA, SHA, WA both pre and post-operatively. Results: Scoliosis was successfully corrected in both groups. All patients obtained good coronal and sagittal balance, and no severe complications occurred. The post-operative apical rotation corrective rate of the DVR and non-DVR groups were 67% and 26% respectively (P< 0.05). In the DVR group, the mean main thoracic Cobb angle decreased from 67.05 ±15.3° on pre-operative to 3.15 ± 3.76° on the immediate postoperative and 3.15 ± 3.76°on the last follow-up with a mean immediate correction index of 95.45 ± 4.06% and late follow up correction index 85.3 ± 19.15%. In the non-DVR group, mean thoracic Cobb angle decreased from 64.3 ± 12.99°on pre-operative to 9.6 ± 8.22° on the immediate postoperative and 9.75 ± 8.06°on the last follow-up with a mean immediate correction index of 77.0 ± 23.17°and late follow up correction index 77.0 ± 23.17°. There is a statistically highly significant difference between both groups regarding RH differences and a significant correlation was found between the reduction in apical vertebral rotation in the DVR group. The postoperative mean Rh diff of the DVR and non-DVR were. 6.35 ± 6.78mm and 22.9 ± 7.93 mm respectively. There is a statistically significant difference between both groups regarding AVT1, AVT2 postoperatively with better correction in the DVR group. 6.6 ±5.54 mm, 9.75 ± 9.32 mm versus 9.8 ± 6.13 mm, 24.0 ± 4.62 mm in the non-DVR group. There is no significant difference in GCB, GSB, TK, LL, and shoulder balance parameters (C1RID and T1 tilt) between both groups. Conclusion: The corrective maneuver using DVR for idiopathic scoliosis allowed for a good triplanar deformity correction with additional reduction in vertebral body rotation, direct rib hump correction without compromising thoracic kyphosis formation, and improved patient’s quality of life and self-image.