A posterior fusion is the standard operative approach that will allow the orthopaedic surgeon to treat most scoliosis satisfactorily. The extent of fusion should be determined by the type and extent of the curve. All spines should not be fused from T4 to L4. The management of the blood loss has evolved to a very controlled situation, with the reasonable goal that no patient should be sensitized to homologous blood. Instrumentation systems provide good correction and stability to assist in providing a solid fusion. There are advantages and disadvantages to each instrumentation system, and the trade-offs should be considered for each patient. Finally, what our patients want more than anything else from these operations is safety, and we should strive to provide that for them.