This article provides an overview of the management of Adolescent idiopathic scoliosis over the last 20 years by a single study group of 29 surgeons. The authors point out some of the shortcomings of the study and one could always question the veracity and the reliability of data from multiple centers in this retrospective review, or the unknown factors of individual surgeon decision making and so on. This data set gives individual surgeons, the opportunity to compare their own practice results to this “peer” series to say; “how am I doing.” This internal quality control is important for each of us to perform on a continual basis. What is missing in the article and must be addressed by the larger community of spine deformity surgeons is the value proposition of the care we provide. The US healthcare system and most healthcare systems around the world are strained financially. Collectively we need to evaluate treatments and assess costs/outcome. Yes, decreased length of stay and lower transfusion rates saves money without adversely affecting quality. However, total hospital charges have dramatically increased since 2003 mostly driven by implant costs. In the new healthcare paradigm, we must always take into account every aspect of the care we provide and justify the costs of what we do per the value we provide for that cost. The other issue not discussed in this article but one that this study group and others must address is long-term outcomes.