Does Pelvic Fixation in Neuromuscular Scoliosis Correction Affect Radiological and Functional Outcomes?

Area of Science:

• Orthopedics
• Spine Surgery
• Pediatric Spine Deformities

Background:

• Pelvic fixation is a common surgical technique for neuromuscular scoliosis with pelvic obliquity (PO) exceeding 15 degrees.
• The comparative benefit of pelvic fixation versus shorter constructs in these patients remains incompletely understood.

Purpose of the Study:

• To systematically review and compare radiological, functional, and surgical outcomes between neuromuscular scoliosis patients treated with and without pelvic fixation.
• To evaluate the efficacy of pelvic fixation in correcting spinal and pelvic deformities.

Main Methods:

• A systematic review of five studies involving 230 patients (120 with pelvic fixation, 110 without).
• Analysis of radiographic parameters (Cobb angle, pelvic obliquity), functional scores (SF-36, GMFCS, etc.), estimated blood loss, and complication rates.

Main Results:

• Radiographic correction of Cobb angle and pelvic obliquity was comparable between groups.
• Functional outcomes were largely similar, with no consistent advantage found for pelvic fixation across various assessment tools.
• Estimated blood loss was higher in the pelvic fixation group, though not statistically significant; complication rates were similar.

Conclusions:

• Routine pelvic fixation is not universally recommended for neuromuscular scoliosis due to heterogeneous outcomes and lack of clear functional benefit over shorter constructs.
• Individualized surgical planning is crucial, with potential benefits for pelvic fixation in specific subgroups, such as non-ambulatory patients with severe pelvic obliquity or poor trunk control.