This spine surgery lecture looks at Early Onset Scoliosis, beginning with a discussion of the natural outcome of disease, and how various medical conditions develop due to negligence of these cases such as cardiac and pulmonary issues. This is followed by an overview of the conservative treatment options, including casts, bracing and traction, with an explanation of the role of each modality in successful management. The lecture then moves on to look at operative modalities, including growing rod constructs and rib distractor devices, and their use in preservation of growth potential and how to minimise their impact in growth retardation. Finally, situations are presented in which the operative treatments can be more detrimental than the disease itself.