Early-onset scoliosis is defined as a coronal curvature of the spine greater than 10 degrees diagnosed before age 10, regardless of its underlying etiology [1, 2]. The natural history and prognosis of early-onset scoliosis depend on its etiology and associated conditions. Progression of spinal deformity in early-onset scoliosis is intrinsically associated with age at the time of diagnosis and growth remaining. The first five years of life are critical for managing early-onset scoliosis curves, because rapid growth and thoracic development occur during this time, making early intervention crucial to prevent truncal shortening and secondary cardiopulmonary complications [3–5]. The management of progressive scoliosis in an immature spine is particularly challenging and has become an area of increasing concern in the literature. A wide variety of treatment options for  early-onset scoliosis have been described, ranging from non-operative approaches to growth-friendly surgical interventions and spinal fusion. Historically, spine fusion was considered appropriate at an early age, under the assumption that a short but straight spine was preferred over a long, crooked one. It is now well understood that fusing the spine during periods of substantial lung development has an adverse effect on cardiopulmonary physiology [6, 7]. The goal of early-onset scoliosis treatment, irrespective of etiology, is to try to control and correct the spinal deformity while maximizing thoracic volume and pulmonary function [5–8].