Casting for scoliosis has evolved significantly since it was first reported 150 years ago. Earlier techniques focused on temporizing scoliosis, loosening up curves prior to surgery and facilitating fusions after surgery. Modern techniques have evolved to address the three dimensional nature of the deformity and to harness the power of growth in younger children to provide a lasting correction. Its current iteration, elongation derotation flexion casting, has been successfully applied in multiple patient populations. It has been shown to cure anywhere from 35-69% of patients with infantile idiopathic scoliosis and will palliate many more. It can delay surgical intervention two or more years in patients with congenital, syndromic or neuromuscular scoliosis.