Background <p>Severe and rigid spinal deformities pose significant surgical challenges, with conventional posterior fusion often limited by curve stiffness and risk of neurological injury. Temporary internal distraction (TID) has been introduced as an adjunct to facilitate safer staged correction.</p> Methods <p>A systematic review of the literature was conducted in accordance with PRISMA guidelines. Studies reporting clinical or radiological outcomes of TID in severe spinal deformities were included. Data on study characteristics, patient demographics, surgical techniques, outcomes, and complications were extracted. Methodological quality was assessed using the MINORS scale.</p> Results <p>Fifteen studies comprising 243 patients were included. The majority were retrospective case series of moderate methodological quality. TID consistently improved curve flexibility and resulted in significant reductions in main thoracic, thoracolumbar/lumbar, and kyphotic angles, with gains maintained at final follow-up. Improvements were also observed in apical vertebral translation, lumbar lordosis, spinal length, and rib hump height. Pulmonary outcomes were infrequently reported, precluding meta-analysis. Complications included transient neuromonitoring changes, rare neurological deficits, pulmonary complications, infections, and implant-related failures, but overall safety was acceptable.</p> Conclusion <p>TID appears to be a promising adjunct for managing severe and rigid spinal deformities, enabling safer staged correction and significant radiological improvement with manageable risks. Retrospective designs and heterogeneous reporting limit current evidence; further prospective studies with standardised functional outcomes are needed to define its long-term role.</p>