Pediatric spinal deformity is a relatively common disorder with significant societal and patient economic burden. Surgical fixation can be costly. An inappropriate delay in surgery or the wrong type of surgery can be more costly. Because of the incidence of disease, standardization and protocolization of treatment paradigms have the potential to result in large societal cost savings. At an institutional level, pediatric spine surgery is a large economic driver for pediatric orthopedic spine divisions. Combined orthopedic and neurosurgery cases may come with increased patient benefit. This may, however, be economically disadvantageous to the hospital system in smaller time horizons. Although regionally variable, pediatric spine work may come at a financial opportunity cost for the adult spine surgeon.