Prospective data from a multicenter registry was reviewed retrospectively. In 8- to 11-year-old idiopathic early-onset scoliosis (EOS) patients, the researchers sought to compare the outcomes of posterior spinal fusion (PSF) with magnetically controlled growth rods (MCGR) versus vertebral body tethers (VBT). PSF, MCGR, or VBT were performed on 130 idiopathic EOS patients; 81% were female and were aged 8–11 years old at the time of the index operation (mean 10.5 years). Preoperatively and at the most recent follow-up (before final fusion for VBT/MCGR), the scoliosis curve, kyphosis, thoracic and spinal height, complications, and Quality of Life (QoL) were examined. VBT was given to 28.5% of the 130 patients, MCGR to 39.2%, and PSF to 32.3%. The VBT cohort had a higher percentage of females (P<0.0005), was older (P<0.0005), had more skeletal maturity (P<0.0005), and had more petite major curves (P<0.0005). Scoliosis curves corrected somewhere between 41.1 ± and 22.4% in VBT, somewhere between 52.2 ± 19.9% in PSF, and somewhere between 27.4 ± 23.9% in MCGR at follow-up (P<0.0005); however, not all VBT/MCGR patients completed treatment. In 10 VBTs, 15 problems occurred, 6 of which necessitated unplanned surgery; 45 complications happened in 31 MCGRs, 11 of which necessitated unexpected surgery; and 9 complications occurred in 6 PSFs, 3 of which necessitated unexpected revisions. When adjusted for age, gender, and preoperative scoliosis curve, Cox proportional hazards regression revealed that MCGR (HR=21.0, 95% C.I. 4.8–92.5; P<0.001) and VBT (HR=7.1, 95% C.I. 1.4–36.4; P=0.019) patients had a higher risk of requiring revision, but only MCGR patients (HR=5.6, 95% C.I. 1.1–28. In all groups, thoracic and spinal height increased. Patients with VBT and PSF had better QoL than those with MCGR. MCGR, PSF, and VBT effectively controlled curves and enhanced spinal size in older idiopathic EOS patients. VBT and PSF, on the other hand, had a decreased risk of an arbitrary revision and better QoL.