The use of intraoperative skull-skeletal traction provides initial correction to the curve prior to incision. Depending on the weight used, the magnitude of the coronal Cobb angle can decrease by 50% compared to the preoperative standing film (3, 4, 5). This significant reduction in the curve can expedite spine exposure, provide derotation and translation to the curve facilitating screw insertion, and aid in the correction of the deformity and rod placement. While bilateral femoral traction is used in cases with a level pelvis (Fig. 48-1A), in the presence of pelvic obliquity, unilateral traction (Fig. 48-1B) on the high pelvic side can be used to level the pelvis (6, 7).

With the traction in place, standard curve correction techniques can be utilized to further correct the deformity. The traction is placed just prior to flipping the patient onto the operating room table after the anesthetic induction has been completed. Once the rods are inserted and the correction is completed, the weight of the traction is removed. The pins are removed in the operating room at the conclusion of the case prior to the patient being awakened from the anesthesia.