Purpose <p>In many centers, extra bone graft or bone substitute is used in routine surgery for adolescent idiopathic scoliosis (AIS). We examined the existing evidence to determine whether local bone graft (LBG) alone is sufficient.</p> Methods <p>We performed the literature search through PubMed and Web of Science, using the search terms “scoliosis” and “bone graft.” The inclusion criteria were primary posterior AIS surgery, the use of LBG exclusively, and segmental placement of anchors. Studies that provided a control group were added to the meta-analysis. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool and version 2 of the Risk of Bias tool for randomized trials (RoB 2) was used. The inverse variance method and the random effects model meta-analysis were chosen.</p> Results <p>Six studies involving 549 patients were eligible. One study reported occasional use of posterior column osteotomy. Adding bone graft did not reduce the occurrence of pseudoarthrosis (odds ratio 0.94; 95% confidence interval 0.40–2.22; <i>p</i> = 0.89; <i>I</i>² = 0). Although not significant, the direction of effect was in favor of LBG alone (intervention group). Two studies reported Scoliosis Research Society Scores, which were similar in both groups.</p> Conclusions <p>LBG can be used alone in AIS patients with posterior segmental instrumentation. Extra material may not be needed in routine cases.</p>