Abstract
Purpose Severe pediatric spinal deformities often require preoperative traction to improve surgical safety and correction. This review examines the burden of deformities, current surgical approaches, and traction technologies to identify challenges and opportunities for improvement. Methods A two-stage literature review was conducted, first assessing the burden and surgical management of significant and severe pediatric spinal deformities, then focusing on traction modalities and associated technologies. Results Three primary traction approaches, halo gravity, halo pelvic, and halo femoral, were evaluated in addition to some recent alternative approaches. While clinically effective, their application remains highly variable in force delivery and inpatient protocols. Conclusion Preoperative traction remains the gold standard for severe pediatric spinal deformities, but current practices are inconsistent in force application. Standardization and modernization are needed to optimize outcomes and improve patient quality of life.