The optimized enhanced recovery after surgery (ERAS) pathway in patients with early onset scoliosis (EOS) has not yet been comprehensively described. This study explored the efficacy and feasibility of an integral process of the ERAS pathway in posterior spinal fusion (PSF) surgery in EOS patients. A total of 70 patients were included in this study, with 35 patients receiving treatment using an ERAS pathway designed and implemented by a multidisciplinary team. The remaining 35 patients followed the traditional pathway (TP) perioperative care. Patient demographics, radiographic parameters, surgical data, and clinical information were collected and analyzed retrospectively. There were no significant differences in sex, height, weight, age, body mass index, preoperative hemoglobin level, fusion segments, number of screws, Cobb angle of the main curve, or surgical duration between the ERAS and TP groups. Regarding pain intensity, the estimated blood loss (EBL), first ambulation time, length of analgesic use, postoperative length of stay (LOS), drainage duration, drainage volume, and incidence of blood transfusion were significantly lower in the ERAS group than in the TP group. The ERAS pathway in EOS orthopedic surgery effectively reduces intraoperative bleeding, alleviates postoperative pain, reduces com-plications, accelerates recovery, and shortens hospital stays. Therefore, spinal surgeons should adopt the ERAS pathway in EOS surgery.