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Background <p>The decision of whether to extend fixation to the pelvis or stop at the lumbar spine during neuromuscular scoliosis (NMS) surgery is still controversial. While pelvic fixation (PF) provides enhanced stability, it may increase surgical morbidity. On the other hand, lumbar fusion short of the pelvis (FSP) offers reduced complexity but risks loss of correction over time.</p> Objective <p>To systematically review and meta-analyze the comparative outcomes of PF versus FSP in patients with NMS undergoing posterior spine fusion (PSF).</p> Methods <p>We conducted a comprehensive search of the PubMed and Ovid databases for English-language studies published between 2010 and 2025. We included comparative studies evaluating PF and FSP in patients with NMS undergoing PSF. We extracted data on radiographic correction, correction loss, perioperative parameters, complications, revision rates, and functional outcomes. We assessed the risk of bias using the MINORS tool and performed pooled analyses according to the PRISMA guidelines.</p> Results <p>A total of 10 studies involving 1685 patients were included. There were no significant differences in estimated blood loss, hospital stay, scoliosis correction, pelvic obliquity correction, overall complication rates, or reoperation rates between the PF and FSP groups (<i>p</i> &gt; 0.05). However, PF was associated with a longer operative time (mean difference [MD] -0.92; 95% confidence interval [CI]: 0.25, 1.58; I²=87%, <i>p</i> = 0.007), though it provided better PO maintenance at the final follow-up (MD -3.68; 95% CI: -6.1, -1.26; I²=58%, <i>p</i> = 0.003). Though evidence was limited, functional outcomes and quality-of-life scores were similar between groups.</p> Conclusion <p>Both PF and FSP achieve satisfactory deformity correction in patients with NMS undergoing PSF. PF is recommended for patients with severe PO (&gt; 15°-17°), dependent sitting balance, or spastic neuromuscular conditions. FSP is suitable for patients with more flexible curves, sufficient trunk control, and PO &lt; 15°. Individualized surgical planning based on radiographic and functional assessments is essential to optimizing outcomes.</p>

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Optimal distal fusion level in patients with neuromuscular scoliosis: a meta-analysis of comparative studies with 1685 patients over 15 years

  • 期刊论文

  • 发表日期：

    2026年5月16日

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  • Bicheng Yong,
  • Subaraman Ramchandran,
  • Federico Canavese

摘要

Background

The decision of whether to extend fixation to the pelvis or stop at the lumbar spine during neuromuscular scoliosis (NMS) surgery is still controversial. While pelvic fixation (PF) provides enhanced stability, it may increase surgical morbidity. On the other hand, lumbar fusion short of the pelvis (FSP) offers reduced complexity but risks loss of correction over time.

Objective

To systematically review and meta-analyze the comparative outcomes of PF versus FSP in patients with NMS undergoing posterior spine fusion (PSF).

Methods

We conducted a comprehensive search of the PubMed and Ovid databases for English-language studies published between 2010 and 2025. We included comparative studies evaluating PF and FSP in patients with NMS undergoing PSF. We extracted data on radiographic correction, correction loss, perioperative parameters, complications, revision rates, and functional outcomes. We assessed the risk of bias using the MINORS tool and performed pooled analyses according to the PRISMA guidelines.

Results

A total of 10 studies involving 1685 patients were included. There were no significant differences in estimated blood loss, hospital stay, scoliosis correction, pelvic obliquity correction, overall complication rates, or reoperation rates between the PF and FSP groups (p > 0.05). However, PF was associated with a longer operative time (mean difference [MD] -0.92; 95% confidence interval [CI]: 0.25, 1.58; I²=87%, p = 0.007), though it provided better PO maintenance at the final follow-up (MD -3.68; 95% CI: -6.1, -1.26; I²=58%, p = 0.003). Though evidence was limited, functional outcomes and quality-of-life scores were similar between groups.

Conclusion

Both PF and FSP achieve satisfactory deformity correction in patients with NMS undergoing PSF. PF is recommended for patients with severe PO (> 15°-17°), dependent sitting balance, or spastic neuromuscular conditions. FSP is suitable for patients with more flexible curves, sufficient trunk control, and PO < 15°. Individualized surgical planning based on radiographic and functional assessments is essential to optimizing outcomes.