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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. It is not without its limitations including rashes, pressure sores, rib deformity and the potential long-term impact of repetitive anesthesia. Additionally, there continues to be variable outcomes in part due to the heterogeneous patient population and variability in casting techniques. However, the technique continues to improve as it evolves and it is the only treatment that can potentially cure scoliosis. Here we aim to discuss the evolution of casting, its application in different patient populations, and the tips and tricks of our preferred casting technique.