Compression-distraction spinal fixation systems, and methods of performing compression-distraction spinal fixation, are provided that include screw-rod constructs having a ratcheting mechanism. Bone screws of the screw-rod constructs can have a pawl that engages ratchet teeth on the rod of the screw-rod construct. The bone screw can be unidirectionally ratcheted along the length of the rod to apply compressive or distractive forces. Tools for manipulation of the screw-rod constructs are also provided, which tools include distal tips configured to engage the bone screws.