Early-onset scoliosis (EOS) encompasses a complex group of conditions, including congenital, syndromic, neuromuscular, and idiopathic scoliosis. For these challenging cases, increasing value involves cost reduction and optimization of clinical outcomes. Value based themes include utilizing a brace instead of casting to reduce the number of anesthetic events; minimizing office visits to lower overall costs and lessen the burden on patient families; thoughtful use of ionizing radiation in imaging studies to limit long-term radiation risks; delaying the initiation of growth-friendly instrumentation to reduce complications and unplanned returns to the operating room (UPROR); weighing the advantages and disadvantages of each instrumentation type; and tailoring the choice to the specific needs of the patient to potentially reduce cost. Lastly, in the “tweener” population, delaying surgery until a definitive fusion, rather than pursuing a growth-friendly strategy, reduces the total number of surgical procedures and achieves similar long-term results.