Preoperative Halo Traction Versus Direct Posterior Fusion in Severe Adolescent Idiopathic Scoliosis: A Comparative Study

<b>Background/Objectives:</b> This study aimed to evaluate the effect of preoperative halo-gravity traction (HGT) on surgical outcomes in adolescents with severe idiopathic scoliosis (AIS), comparing posterior spinal fusion (PSF) performed with versus without traction in terms of curve correction, complication rates, and overall surgical efficacy. <b>Methods:</b> A retrospective cohort study was conducted on 46 adolescents (mean age 14.6 ± 1.9 years) with severe AIS (Cobb > 65°) treated at a single tertiary center between 2011 and 2024. Sixteen patients underwent primary PSF, and 30 received preoperative HGT followed by PSF. Radiographic parameters-including Cobb angle and Risser grade-were analyzed pre- and postoperatively. Statistical tests (<i>t</i>-test, Mann-Whitney U, and multivariable linear regression) assessed differences in correction and predictors of outcome, with <i>p</i> < 0.05 considered significant. <b>Results:</b> Baseline characteristics were comparable between groups (mean preoperative Cobb: 83.6° ± 11.2° vs. 83.1° ± 15.6°, <i>p</i> = 0.91). The traction cohort achieved significantly smaller postoperative Cobb angles (30.9° ± 7.8° vs. 42.7° ± 18.9°, <i>p</i> = 0.027), greater absolute correction (52.7° ± 7.4° vs. 40.4° ± 10.5°, <i>p</i> < 0.001), and higher percentage correction (63.3% ± 6.7% vs. 50.0% ± 14.0%, <i>p</i> = 0.002). Regression analysis confirmed HGT as an independent predictor of improved correction (+14.6%, 95% CI +6.9-22.3%, <i>p</i> = 0.00047). No neurological or major complications occurred, and most correction was achieved within the first three weeks of traction. <b>Conclusions:</b> Preoperative halo-gravity traction significantly enhances deformity correction and surgical safety in severe AIS without added morbidity. Most benefit occurs within 21 days, supporting shorter, standardized traction protocols. HGT remains a valuable adjunct for optimizing outcomes in rigid scoliosis prior to posterior spinal fusion.