The early principles of spinal fusion in the adolescent population focused on preventing progression while simultaneously correcting the spinal deformity. These principles have remained relatively unchanged since their introduction more than a century ago, but recent improvements in imaging, instrumentation, and corrective techniques have provided new insight on the diagnosis, management, and postoperative care of this condition. Treatment options for the management of patients with early onset scoliosis have also evolved dramatically over the last 2 decades. Further knowledge on the physiology of lung development and the detrimental effects of early fusion in the early onset scoliosis population has led to the development of growth friendly implants and other surgical techniques that allow correction of the deformity while maintaining spine, lung, and chest wall development. The following is an overview of current techniques on the management of adolescent idiopathic and early onset scoliosis to help provide guidance on the available surgical alternatives to address these conditions.