Pelvic fixation in pediatric spinal fusion for neuromuscular scoliosis is associated with increased short-term complications but no long-term risk
Abstract
Purpose Pelvic fixation is frequently employed in posterior spinal fusion for neuromuscular scoliosis (NMS) to improve alignment and construct stability, particularly in cases with significant pelvic obliquity. However, concerns remain regarding its association with increased surgical complexity and postoperative morbidity. This study aimed to compare short- and long-term postoperative outcomes between pediatric NMS patients who underwent posterior spinal fusion with and without pelvic fixation. Methods A retrospective cohort study was conducted using the TriNetX Research Network. Pediatric patients (≤ 21 years) with NMS who underwent posterior spinal fusion with or without pelvic fixation were identified. Propensity score matching was used to control for differences in demographics, comorbidities, number of vertebral levels fused, and neuromuscular diagnosis. Postoperative complications were assessed at two time windows: short-term (1–365 days) and long-term (≥ 365 days). Results Pelvic fixation was associated with significantly higher rates of short-term complications, including surgical site infection, wound breakdown, and overall postoperative infection. In contrast, no significant differences were observed between groups in long-term complication rates. Mechanical and hardware-related complications—such as device failure, pseudarthrosis, revision surgery, and additional instrumentation—were similar between groups during both follow-up periods. Conclusion Pelvic fixation in pediatric posterior spinal fusion for NMS is associated with increased short-term morbidity but does not lead to higher rates of long-term complications or hardware-related failure. These findings suggest that the short-term risks of pelvic fixation diminish over time and that its long-term safety profile is comparable to constructs that do not include the pelvis.
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