Introduction Severe rigid spinal deformities (Cobb angle >90°, flexibility <25%) remain among the most challenging conditions in spine surgery, with high risks of neurological injury, cardiopulmonary compromise, and suboptimal correction. Pre‑operative staged skull‑femoral traction (SFT) may facilitate gradual deformity mobilization and pulmonary optimization, potentially reducing the morbidity of subsequent spinal osteotomy and posterior instrumented spinal fusion (PSF). This study evaluates the radiographic, pulmonary, and functional outcomes of this staged approach at three‑year follow‑up.

Material and Methods: Seventeen consecutive patients (11 females, 6 males; mean age 22.4 ± 6.1 years) with severe rigid scoliosis or kyphoscoliosis underwent staged SFT (mean duration 19.1 ± 4.6 days; mean traction weight 36.2% ± 6.1% body weight) followed by spinal osteotomy and PSF between 2021–2023. Minimum follow‑up was 24 months (mean 26.8 ± 2.4). Outcomes included coronal and sagittal correction, pulmonary function (FVC % predicted), complications, and SRS‑22 functional scores.

Results: The mean pre‑traction coronal Cobb angle of 116.9° ± 13.4° improved to 73.5° ± 11.2° after traction and further to 50.7° ± 9.6° post‑fusion, representing an overall correction of 57%. Sagittal kyphosis decreased from 95.1° ± 15.1° to 55.6° ± 10.2° postoperatively (42% correction). Pulmonary function improved significantly, with mean FVC increasing from 57.6% ± 6.8% predicted preoperatively to 72.3% ± 6.1% at final follow‑up (p<0.05). Functional outcomes also improved, with SRS‑22 scores rising from 2.9 ± 0.5 to 4.3 ± 0.4. Complications included two transient neurological deficits that resolved completely and three superficial pin‑site infections, with no permanent morbidity or mortality. All patients reported improved balance, posture, and pain relief at follow‑up.

Conclusion: Pre‑operative staged SFT followed by spinal osteotomy and PSF is a safe and effective strategy for severe rigid spinal deformities. This protocol achieved substantial coronal and sagittal correction, significant pulmonary improvement, and durable functional gains with low complication rates. The staged approach represents a valuable alternative to high‑risk single‑stage osteotomies in carefully selected patients.