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Background.Distal adding-on is often accompanied by unsatisfactory clinical outcome and high risk of revision surgery.Although several studies have investigated factors associated with adding-on,few studies have focused on the progression of distal adding-on.The purpose of the study is to identify the prevalence of post-operative distal adding-on in Lenke 1A and 2A scoliosis and to investigate the risk factors for the progression of post-operative distal adding-on.