Preoperative optimization and advanced imaging are critical for successful pediatric spinal deformity surgery using enabling technologies like navigation and robotics, which enhance pedicle screw placement accuracy. Comprehensive radiographic evaluation, including low-dose EOS imaging and protocolized CT/MRI, supports precise surgical planning with software to optimize screw trajectories and implant constructs. Unique considerations for severe deformities and potential intraoperative risks, such as platform failure or registration inaccuracies, necessitate meticulous planning and intraoperative vigilance to ensure optimal outcomes.