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

Pelvic fixation is commonly used in neuromuscular scoliosis patients with pelvic obliquity (PO) >15°, yet its benefit over shorter constructs remains unclear. This systematic review analyzed five studies comprising 230 patients (120 with pelvic fixation (WPF), 110 without pelvic fixation (WoPF)) to assess radiological, functional, and surgical outcomes. Radiographic correction was similar between groups: Cobb angle improved from 62.8° to 32.4° in WPF vs. 76.7° to 29.4° in WoPF (p = 0.54), and PO correction did not differ significantly (final PO 8.6° vs. 11.5°, p = 0.5). Functional outcomes were heterogeneous; only one study reported a statistically significant benefit in the WPF group (Short-Form Health Survey-36 improvement, p = 0.007), while others using Gross Motor Function Classification System (GMFCS), Caregiver Priorities and Child Health Index of Life With Disabilities, or Bridwell's scores found no advantage. GMFCS data were reported in just 19% of patients, limiting subgroup analysis. Estimated blood loss was substantially higher in WPF (2,851 mL vs. 1,383 mL), though not statistically significant (p = 0.17), with comparable complication rates. Given the heterogeneity in outcome measures, surgical technique, and patient function, routine pelvic fixation cannot be universally recommended. However, it may benefit select subgroups, such as non-ambulatory patients with severe PO or poor trunk control, warranting individualized surgical planning.