Pelvic fixation in pediatric spinal fusion for neuromuscular scoliosis is associated with increased short-term complications but no long-term risk

Pelvic fixation in pediatric spinal fusion for neuromuscular scoliosis is associated with increased short-term complications but no long-term risk | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pelvic fixation in pediatric spinal fusion for neuromuscular scoliosis is associated with increased short-term complications but no long-term risk Yoli Meydan, Gregory Sacks, James Barsi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6857170/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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. Pelvic fixation neuromuscular scoliosis scoliosis pediatric spinal fusion pediatric spine pediatric deformity Figures Figure 1 Figure 2 INTRODUCTION Neuromuscular scoliosis (NMS) is a spinal deformity that develops in children secondary to neuromuscular conditions such as cerebral palsy, spina bifida, and muscular dystrophy[ 1 ]. These conditions impair motor control, muscle tone, and postural balance, often resulting in progressive curvature of the spine and associated complications including pelvic obliquity, impaired sitting balance, and respiratory dysfunction[ 1 ]. While non-surgical interventions such as physical therapy or wheelchair modifications may offer temporary relief, spinal fusion remains the standard of care for severe or progressive curves[ 2 ]. This procedure—which involves permanently joining segments of the spine using rods, screws, and bone grafts—can achieve up to 75–80% overall correction of deformity, along with alleviation of pain and improvement in difficulty sitting[ 3 ]. One major consideration in posterior spinal fusion for NMS is whether to extend the instrumentation caudally to include the pelvis. In patients with significant pelvic obliquity or severe spinal imbalance (commonly defined as pelvic obliquity > 15°, apex of curvature 60°), pelvic fixation can help achieve a more level pelvis and better coronal and sagittal alignment[ 4 , 5 ]. However, this added procedure increases surgical complexity and has also been associated with longer operative times, greater blood loss, and higher rates of wound and implant-related complications[ 6 , 7 ]. The decision to include pelvic fixation therefore remains a long-standing point of debate, with no clear consensus currently established in the literature. While previous studies have investigated the postoperative complications and short-term risks of pelvic fixation[ 6 – 9 ], these investigations have largely relied on single-center cohorts, limiting both statistical power and generalizability. In addition, few have directly compared outcomes to non-pelvic fixation cohorts and examined whether these risks persist beyond the early postoperative period, and none have done so at a large scale[ 6 , 7 , 10 , 11 ]. To date, no study has comprehensively evaluated both short- and long-term postoperative outcomes of pelvic fixation in pediatric NMS using a large, nationally representative dataset. Such an analysis is critical to better inform surgical decision-making and clarify the long-term impact of pelvic fixation. METHODS Study Design This was a retrospective cohort study conducted using de-identified electronic health records from the TriNetX Research Network, a federated database that aggregates pre-existing clinical data from 106 health care organizations. The dataset includes diagnoses, procedures, and laboratory values coded using the International Classification of Diseases, Tenth Revision (ICD-10), and Current Procedural Terminology (CPT) codes. All data is de-identified in accordance with Section § 164.514(a) of the HIPAA Privacy Rule, and is therefore exempt from informed consent requirements and institutional review board (IRB) approval. The study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Cohort Selection This study evaluated short- and long-term postoperative complications in adolescents undergoing posterior spinal fusion for neuromuscular scoliosis, comparing outcomes between patients who did and did not receive pelvic fixation. Patients aged ≤ 21 years who underwent posterior spinal fusion were identified using the following CPT codes: 22800, 22802, and 22804. Pelvic fixation was defined by CPT code 22848 or ICD-10-PCS codes 0SG7 and 0SG8, which capture sacroiliac joint fixation procedures. To define the neuromuscular scoliosis population, we included patients with a diagnosis of NMS and/or related neuromuscular disorders, such as cerebral palsy, spina bifida, and muscular dystrophy. To reduce the risk of confounding, patients with congenital or syndromic scoliosis (e.g., Marfan syndrome, Ehlers-Danlos syndrome, neurofibromatosis, and osteogenesis imperfecta) were excluded. Patients with a prior history of deformity surgery were also excluded from the query. A full list of inclusion/exclusion criteria and associated codes are detailed in Supplementary Table 1, and a schematic overview of cohort selection is shown in Fig. 1 . 1:1 Propensity Matching To minimize baseline differences between cohorts and reduce selection bias, the TriNetX platform was used to perform 1:1 propensity score matching using logistic regression. A greedy nearest neighbor algorithm with a caliper of 0.1 pooled standard deviations was applied, ensuring that matched pairs had a maximum allowable difference in propensity scores of ≤ 0.1. All variables used for matching were collected up to and including the date of the index surgery, ensuring that only preoperative characteristics were used to avoid post-exposure bias. Matching variables included demographic characteristics, relevant comorbidities, and intraoperative variables such as number of vertebral levels fused and use of instrumentation. Crucially, we also matched on the underlying neuromuscular diagnosis to ensure comparability in disease etiology. Outcomes Postoperative outcomes were assessed across two distinct follow-up periods: a short-term window defined as 1 to 365 days following the index surgery, and a long-term window beginning at 365 days postoperatively and extending through the most recent available follow-up at the time of query. The data query encompassed a 20-year period, allowing for both short- and long-term complications to be comprehensively assessed through the most up-to-date clinical records available. All outcomes were defined using standardized ICD-10 and CPT codes, and included surgical site infection, any infection (including deep infections and those related to orthopedic devices, implants, or grafts), wound breakdown, device failure, sepsis, reduced mobility, pseudarthrosis, removal of hardware or graft, additional instrumentation, and revision surgery. Revision surgery was defined broadly and included any return to the operating room related to the index procedure, encompassing removal of hardware or graft, insertion of new devices, and other reoperations. A full list of postoperative outcomes and their associated codes is provided in Supplementary Table 2. RESULTS Before matching, the cohort included 918 patients who underwent pelvic fixation and 1,412 patients who did not. Following 1:1 matching, 534 matched pairs remained for analysis. As shown in Table 1 , all covariates were successfully reduced to standardized mean differences less than 0.1, indicating appropriate balance between groups and successful mitigation of selection bias. Within the first year following surgery, patients who underwent pelvic fixation experienced significantly higher rates of several postoperative complications compared to matched controls (Table 2 ). Surgical site infection occurred in 35 (6.6%) of pelvic fixation cases versus 12 (2.3%) of controls (RR 2.92, 95% CI 1.53–5.56, p < 0.001), while wound breakdown was observed in 66 (12.4%) versus 33 (6.2%) of patients, respectively (RR 2.00, 95% CI 1.34–2.98, p < 0.001). Rates of any postoperative infection—whether superficial or deep as well as infections related to internal orthopedic devices, implants, or grafts—were also elevated in the pelvic fixation group (54 [10.1%] vs. 31 [5.8%]; RR 1.74, 95% CI 1.14–2.66, p = 0.009). In contrast, no statistically significant differences were observed between groups during the long-term follow-up period beginning 365 postoperatively (Table 3 ). As shown in Fig. 2 , outcomes that were highly significant in the short term showed convergence over time, with no significant differences observed in the long-term window (wound breakdown: RR 1.10, p = 0.753; any infection: RR 1.46, p = 0.141; SSI: RR 1.00, p = 1.000). Notably, there were no significant differences between groups in key orthopedic hardware-related complications during either the short-term (1–365 days) or long-term (≥ 365 days) follow-up periods. Device failure occurred in 10 (1.9%) of patients in both groups during the first year (RR 1.00, p = 1.000), and in 13 (2.4%) of pelvic fixation patients versus 10 (1.9%) of controls in the long term (RR 1.30, p = 0.527). Rates of additional instrumentation were 12 (2.3%) vs. 13 (2.4%) in the short term (RR 0.92, p = 0.840) and 12 (2.3%) vs. 19 (3.6%) in the long term (RR 0.63, p = 0.202). Revision surgery was performed in 16 (3.0%) of pelvic fixation patients versus 18 (3.4%) of controls in the short term (RR 0.89, p = 0.727), and in 15 (2.8%) vs. 22 (4.1%) in the long term (RR 0.68, p = 0.241). Pseudarthrosis occurred in 47 (8.8%) of pelvic fixation patients compared to 56 (10.5%) of controls within the first year (RR 0.84, p = 0.351), and in 52 (9.7%) vs. 48 (9.0%) beyond one year (RR 1.08, p = 0.674). Removal of hardware occurred in 10 (1.9%) of patients in both groups in the short term (RR 1.00, p = 1.000) and in 11 (2.1%) vs. 14 (2.6%) in the long term (RR 0.79, p = 0.544). DISCUSSION To our knowledge, this is the first multicenter database study to compare both short- and long-term outcomes in pediatric patients undergoing posterior spinal fusion for NMS with and without pelvic fixation. Using a large, nationally representative dataset and propensity-matched cohorts, we found that pelvic fixation was associated with significantly higher rates of short-term complications, including surgical site infection, wound breakdown, and overall infection. After the first postoperative year, however, all outcomes—including both soft tissue and hardware-related complications—were comparable between groups. We defined long-term follow-up as beginning at 365 days postoperatively, based on the typical timeline for bone fusion, wound healing, and resolution of early inflammatory responses[ 12 ]. This threshold also reflects the biology of spinal arthrodesis, which unfolds over distinct phases and continues well beyond the initial postoperative period 29 . Diagnosing pseudarthrosis before 12 months may therefore be premature, as incomplete remodeling and delayed graft incorporation can mimic nonunion during this period. Defining our window in this manner also ensures that outcomes classified as “long-term” truly reflect new or delayed postoperative events rather than misclassified short-term complications that may have persisted. In the short term, pelvic fixation was associated with a two- to three-fold increase in the risk of postoperative soft tissue complications compared to the non-pelvic fixation cohort (Table 2 ). Notably, approximately 65% of surgical site infections and 50% of wound breakdowns observed in the pelvic fixation group could be attributed to the fixation. These findings are not unexpected given the increased surgical complexity and extent of dissection required for pelvic fixation[ 5 , 13 , 14 ]. Various methods of pelvic fixation—both traditional[ 4 ] and modern[ 6 , 15 ]—often involve more extensive exposure and additional hardware placement, which can prolong operative time, increase blood loss, and disrupt soft tissue. These factors are well-established contributors to higher rates of postoperative wound complications and infection[ 16 ], and likely underlie the elevated short-term morbidity observed in our cohort. Our findings align with several studies comparing early postoperative complications in patients undergoing surgical treatment for NMS with and without pelvic fixation. For example, a 2005 study comparing outcomes in 30 patients undergoing fusion to the sacrum with a unit rod versus 25 patients undergoing fusion to L5 with a U-rod found a slightly higher postoperative superficial infection rate in the pelvic fixation group (6.7%, compared to 4.0% in L5 group)[ 7 ]. They did not, however, find any significant difference in the rate of deep wound infections (0% for both groups). Similarly, a 2014 retrospective study of 428 patients with neuromuscular scoliosis found that pelvic fixation was independently associated with more than a two-fold increased risk of deep surgical site infection compared to patients without pelvic instrumentation (OR = 2.4, p = 0.04)[ 16 ]. Notably, wound and infection-related outcomes that were significantly different in the short term showed no statistically significant differences between pelvic and non-pelvic fixation beyond 1 year (Table 3 ). These findings are consistent with previous studies reporting no long-term disadvantage to pelvic fixation. For example, a recent single-institution retrospective study showed no statistical difference in both clinical outcomes and postoperative complications at 2 year follow-up[ 8 ]. Farshad et. al also showed no difference in infection rate (p = 1.0) and wound healing (p = 0.134) between those fixed to the lumbar spine versus the pelvis, with an average follow-up of 56 months[ 14 ]. These results are expected, as surgical site infections and wound complications are typically early postoperative events, and new infections rarely arise after the soft tissues and surgical site have healed. Mechanical outcomes such as device failure, pseudarthrosis, and revision surgery showed no significant differences between pelvic and non-pelvic fixation groups across both short- and long-term periods. This is particularly notable given that constructs terminating at the pelvis often involve more extensive instrumentation and greater biomechanical demands[ 5 , 15 , 17 ]. While our findings generally mirror trends observed in previous studies, reported rates of mechanical failure and revision following pelvic fixation remain highly variable in the literature. For example, one 2022 study reported a 4.3% failure rate within 2 years[ 18 ]—slightly higher than our 2.4% rate in the long-term window. In contrast, Longstein et al. reported a 14.8% revision rate using the Luque-Galveston technique[ 19 ], while a 2019 study found a 17.7% revision rate following spinopelvic fixation with iliac screws[ 20 ]. Notably, some comparative studies report outcomes that differ significantly from ours, showing significantly elevated rates of failure when comparing pelvic fixation to non-pelvic fixation controls. One systematic review reported revision surgery in 14% of patients undergoing pelvic fixation, and 0.8% in those whose fusion terminated at the lumbar spine[ 10 ]. These discrepancies are likely attributable to differences in study design, as well as inconsistent adjustment for comorbidities and a lack of balanced representation of neuromuscular scoliosis etiologies across cohorts. Although our reported rates of pseudarthrosis are relatively high—8.8% vs. 10.5% (pelvic vs. non-pelvic) within the first year, and 9.7% vs. 9.0% beyond one year—there were no statistically significant differences between groups during either follow-up period. These findings fall within the broad range of pseudarthrosis rates reported in the literature for patients undergoing deformity surgery for neuromuscular scoliosis, which vary from as low as 2.2%[ 21 ] to as high as 22.2%[ 22 ]. The lack of significant difference between groups is not unexpected, as pseudarthrosis is likely influenced by numerous patient-specific and systemic factors—such as nutritional status, bone quality, and comorbidities—that may affect fusion rates independently of distal fixation level[ 23 , 24 ]. Interestingly, a 2021 case-control study reported a pseudarthrosis rate of 12.4% in patients undergoing long-segment fusion for adult spinal deformity, and identified pelvic fixation as a significant risk factor[ 25 ]. This discrepancy may be explained by differences in study design and population—namely, the inclusion of all deformity types (not just scoliosis), an adult-only cohort, and the absence of a direct comparison group. This study has several limitations inherent to its retrospective design and use of administrative data. First, although we used robust propensity score matching to reduce baseline differences between groups, residual confounding cannot be ruled out. Second, the use of ICD and CPT codes to define diagnoses and complications may result in misclassification or underreporting of certain outcomes. Third, while the long-term follow-up window extended beyond one year, follow-up duration varied between patients, and some complications may have occurred after the data capture period. Additionally, we could not evaluate radiographic outcomes such as fusion rates or implant positioning, which are not captured in the TriNetX database. And lastly, although our cohort included a broad, nationally representative population, findings may not be generalizable to settings with different patient demographics, surgical practices, or resource availability. Future studies should aim to incorporate radiographic and functional outcomes, enabling a more comprehensive assessment of fusion integrity and postoperative recovery. Additionally, prospective analyses stratified by NMS etiology may help clarify whether certain subgroups derive greater benefit—or risk—from pelvic fixation. CONCLUSION In this multicenter cohort of pediatric spinal fusions for neuromuscular scoliosis, pelvic fixation increased short-term complications but not long-term risk. Notably, rates of mechanical and hardware-related complications—including device failure, pseudarthrosis, and revision surgery—did not differ significantly between pelvic and non-pelvic groups on long-term follow-up. These findings suggest that while pelvic fixation may elevate short-term morbidity, these risks do not persist beyond the early postoperative period. Declarations Author Contribution All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Y.M. and G.I.S. The first draft of the manuscript was written by Y.M., and all authors commented on previous versions of the manuscript. J.B. served as the supervising physician and managing principal investigator. All authors read and approved the final manuscript. Acknowledgement The authors would like to thank all colleagues and mentors at the Renaissance School of Medicine and Department of Orthopedics at Stony Brook University who provided guidance and support throughout the development of this study. Data Availability The data used for analysis in this study were obtained from the TriNetX Research Network and are not publicly available due to privacy and data use agreements. However, the de-identified data used for analysis may be made available from the authors upon reasonable request and with appropriate institutional approvals. 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J Neurosurg Pediatr 22:207–213. https://doi.org/10.3171/2018.2.PEDS17724 Shahzad H, Ahmad M, Singh VK et al (2024) Predictive factors of symptomatic lumbar pseudoarthrosis following multilevel primary lumbar fusion. North Am Spine Soc J NASSJ 17:100302. https://doi.org/10.1016/j.xnsj.2023.100302 Hofler RC, Swong K, Martin B et al (2018) Risk of Pseudoarthrosis After Spinal Fusion: Analysis From the Healthcare Cost and Utilization Project. World Neurosurg 120:e194–e202. https://doi.org/10.1016/j.wneu.2018.08.026 Marques MF, Fiere V, Obeid I et al (2021) Pseudarthrosis in adult spine deformity surgery: risk factors and treatment options. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 30:3225–3232. https://doi.org/10.1007/s00586-021-06861-w Tables Table 1. Baseline characteristics of pediatric patients undergoing posterior spinal fusion for neuromuscular scoliosis, before and after propensity score matching. Before Propensity Score Matching After Propensity Score Matching Characteristic Name Pelvic Fixation (n=918) Non-Pelvic Fixation (n=1412) SMD Pelvic Fixation (n=534) Non-Pelvic Fixation (n=534) SMD Demographics Age at Index 13.00 ± 3.09 13.57 ± 3.25 0.18 13.16 ± 3.20 13.14 ± 3.25 0.01 American Indian or Alaska Native 10 (1.09%) 10 (0.71%) 0.04 10 (1.87%) 10 (1.87%) <0.01 Asian 29 (3.16%) 51 (3.61%) 0.03 16 (3.00%) 16 (3.00%) <0.01 Black or African American 139 (15.14%) 153 (10.84%) 0.13 76 (14.23%) 73 (13.67%) 0.02 Female 430 (46.84%) 736 (52.13%) 0.11 253 (47.38%) 258 (48.32%) 0.02 Hispanic or Latino 121 (13.18%) 196 (13.88%) 0.02 71 (13.30%) 77 (14.42%) 0.03 Male 488 (53.16%) 672 (47.59%) 0.11 281 (52.62%) 276 (51.69%) 0.02 Native Hawaiian or Other Pacific Islander 10 (1.09%) 10 (0.71%) 0.04 10 (1.87%) 10 (1.87%) <0.01 Not Hispanic or Latino 748 (81.48%) 995 (70.47%) 0.26 417 (78.09%) 414 (77.53%) 0.01 White 600 (65.36%) 858 (60.77%) 0.10 337 (63.11%) 350 (65.54%) 0.05 Comorbidities Dependence on wheelchair 391 (42.59%) 308 (21.81%) 0.46 174 (32.58%) 184 (34.46%) 0.04 Diabetes mellitus 10 (1.09%) 11 (0.78%) 0.03 10 (1.87%) 10 (1.87%) <0.01 Disorders of bone density and structure 262 (28.54%) 176 (12.47%) 0.41 110 (20.60%) 121 (22.66%) 0.05 Hypertensive diseases 132 (14.38%) 98 (6.94%) 0.24 49 (9.18%) 50 (9.36%) 0.01 Malnutrition 227 (24.73%) 173 (12.25%) 0.33 107 (20.04%) 102 (19.10%) 0.02 Overweight and obesity 81 (8.82%) 98 (6.94%) 0.07 41 (7.68%) 40 (7.49%) 0.01 Neuromuscular Conditions Cerebral palsy 659 (71.79%) 628 (44.48%) 0.58 350 (65.54%) 347 (64.98%) 0.01 Familial dysautonomia [Riley-Day] 42 (4.58%) 19 (1.35%) 0.19 13 (2.43%) 12 (2.25%) 0.01 Muscular dystrophy 118 (12.85%) 136 (9.63%) 0.10 72 (13.48%) 74 (13.86%) 0.01 Neuromuscular scoliosis 823 (89.65%) 1165 (82.51%) 0.21 456 (85.39%) 447 (83.71%) 0.05 Spina bifida 57 (6.21%) 136 (9.63%) 0.13 41 (7.68%) 39 (7.30%) 0.01 Spinal muscular atrophy and related syndromes 79 (8.61%) 65 (4.60%) 0.16 40 (7.49%) 36 (6.74%) 0.03 Select Procedural Covariates Allograft, morselized, or placement of osteopromotive material, for spine surgery only 654 (71.24%) 975 (69.05%) 0.05 368 (68.91%) 372 (69.66%) 0.02 Allograft, structural, for spine surgery only 10 (1.09%) 106 (7.51%) 0.32 10 (1.87%) 10 (1.87%) <0.01 Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments 858 (93.46%) 896 (63.46%) 0.78 485 (90.82%) 482 (90.26%) 0.02 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments 39 (4.25%) 422 (29.89%) 0.72 31 (5.81%) 30 (5.62%) 0.01 Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments 52 (5.66%) 129 (9.14%) 0.13 33 (6.18%) 36 (6.74%) 0.02 Autograft for spine surgery only W ; local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision 621 (67.65%) 854 (60.48%) 0.15 336 (62.92%) 332 (62.17%) 0.02 Autograft for spine surgery only W ; morselized (through separate skin or fascial incision) 101 (11.00%) 49 (3.47%) 0.29 32 (5.99%) 32 (5.99%) <0.01 Autograft for spine surgery only W ; structural, bicortical or tricortical (through separate skin or fascial incision) 10 (1.09%) 11 (0.78%) 0.03 10 (1.87%) 10 (1.87%) <0.01 Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision 16 (1.74%) 62 (4.39%) 0.15 15 (2.81%) 15 (2.81%) <0.01 Posterior segmental instrumentation F ; 3 to 6 vertebral segments 10 (1.09%) 54 (3.82%) 0.18 10 (1.87%) 11 (2.06%) 0.01 Posterior segmental instrumentation F ; 7 to 12 vertebral segments 19 (2.07%) 375 (26.56%) 0.75 19 (3.56%) 23 (4.31%) 0.04 Posterior segmental instrumentation F ;13 or more vertebral segments 868 (94.55%) 855 (60.55%) 0.89 484 (90.64%) 482 (90.26%) 0.01 W (includes harvesting the graft) F (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires) Table 2. Short-term postoperative complication rates (1–365 days) in pediatric patients undergoing posterior spinal fusion with and without pelvic fixation. Risk (n=534) Complication Pelvic Fixation Non-Pelvic Fixation Risk Ratio 95% CI p-value Surgical Site Infection 35 (6.55%) 12 (2.25%) 2.92 (1.53, 5.56) <0.01* Wound Breakdown 66 (12.36%) 33 (6.18%) 2.00 (1.34, 2.98) <0.01* Any Infection 54 (10.11%) 31 (5.81%) 1.74 (1.14, 2.66) <0.01* Reduced Mobility 145 (27.15%) 118 (22.10%) 1.23 (0.99, 1.52) 0.06 Sepsis 33 (6.18%) 30 (5.62%) 1.10 (0.68, 1.78) 0.70 Removal of Hardware/Graft 10 (1.87%) 10 (1.87%) 1.00 (0.42, 2.38) 1.00 Device Failure 10 (1.87%) 10 (1.87%) 1.00 (0.42, 2.38) 1.00 Additional Instrumentation 12 (2.25%) 13 (2.43%) 0.92 (0.43, 2.00) 0.84 Revision 16 (3.00%) 18 (3.37%) 0.89 (0.46, 1.72) 0.73 Pseudarthrosis/Nonunion 47 (8.80%) 56 (10.49%) 0.84 (0.58, 1.21) 0.35 Table 3. Long-term postoperative complication rates (≥365 days) in pediatric patients undergoing posterior spinal fusion with and without pelvic fixation. Risk (n=534) Complication Pelvic Fixation Non-Pelvic Fixation Risk Ratio 95% CI p-value Any Infection 35 (6.55%) 24 (4.49%) 1.46 (0.88, 2.42) 0.14 Device Failure 13 (2.43%) 10 (1.87%) 1.30 (0.58, 2.94) 0.53 Wound Breakdown 22 (4.12%) 20 (3.75%) 1.10 (0.61, 1.99) 0.75 Pseudarthrosis/Nonunion 52 (9.74%) 48 (8.99%) 1.08 (0.75, 1.57) 0.67 Surgical Site Infection 14 (2.62%) 14 (2.62%) 1.00 (0.48, 2.08) 1.00 Reduced Mobility 194 (36.33%) 199 (37.27%) 0.97 (0.83, 1.14) 0.75 Sepsis 72 (13.48%) 75 (14.04%) 0.96 (0.71, 1.30) 0.79 Removal of Hardware/Graft 11 (2.06%) 14 (2.62%) 0.79 (0.36, 1.71) 0.54 Revision 15 (2.81%) 22 (4.12%) 0.68 (0.36, 1.30) 0.24 Additional Instrumentation 12 (2.25%) 19 (3.56%) 0.63 (0.31, 1.29) 0.20 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6857170","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471552463,"identity":"25306216-1234-41db-88b1-6411fc7cb56d","order_by":0,"name":"Yoli Meydan","email":"","orcid":"","institution":"Stony Brook University","correspondingAuthor":false,"prefix":"","firstName":"Yoli","middleName":"","lastName":"Meydan","suffix":""},{"id":471552464,"identity":"77d10011-158f-4fb7-aaee-2536232a89eb","order_by":1,"name":"Gregory Sacks","email":"","orcid":"","institution":"Stony Brook University","correspondingAuthor":false,"prefix":"","firstName":"Gregory","middleName":"","lastName":"Sacks","suffix":""},{"id":471552465,"identity":"a9b2422a-0028-4668-bbce-201834be4eda","order_by":2,"name":"James Barsi","email":"data:image/png;base64,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","orcid":"","institution":"Stony Brook University Hospital","correspondingAuthor":true,"prefix":"","firstName":"James","middleName":"","lastName":"Barsi","suffix":""}],"badges":[],"createdAt":"2025-06-09 19:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6857170/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6857170/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84870531,"identity":"34f38837-ae28-4210-a342-249e491f67ce","added_by":"auto","created_at":"2025-06-18 08:55:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":181150,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic overview of patient inclusion, exclusion, and cohort stratification\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6857170/v1/24340bd603f65b929f088a96.png"},{"id":84871117,"identity":"70ac608f-8133-4f8e-ae4a-0561442d8e73","added_by":"auto","created_at":"2025-06-18 09:03:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":109362,"visible":true,"origin":"","legend":"\u003cp\u003eRisk ratios of postoperative complications for pelvic fixation versus non-pelvic fixation in pediatric posterior spinal fusion for neuromuscular scoliosis\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6857170/v1/974ba86fd13dd6ae96514669.png"},{"id":95312352,"identity":"eea4033f-27ec-41c5-a767-9c774bf84482","added_by":"auto","created_at":"2025-11-06 15:48:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1065278,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6857170/v1/68698438-7a33-456e-aef2-a7c19a15bcfc.pdf"},{"id":84869257,"identity":"11fc0983-f4b9-4cbd-aa0f-e62c6947d40a","added_by":"auto","created_at":"2025-06-18 08:47:46","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":19956,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6857170/v1/1fe382eb0fd85f3b79b35f40.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pelvic fixation in pediatric spinal fusion for neuromuscular scoliosis is associated with increased short-term complications but no long-term risk","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNeuromuscular scoliosis (NMS) is a spinal deformity that develops in children secondary to neuromuscular conditions such as cerebral palsy, spina bifida, and muscular dystrophy[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These conditions impair motor control, muscle tone, and postural balance, often resulting in progressive curvature of the spine and associated complications including pelvic obliquity, impaired sitting balance, and respiratory dysfunction[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile non-surgical interventions such as physical therapy or wheelchair modifications may offer temporary relief, spinal fusion remains the standard of care for severe or progressive curves[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This procedure\u0026mdash;which involves permanently joining segments of the spine using rods, screws, and bone grafts\u0026mdash;can achieve up to 75\u0026ndash;80% overall correction of deformity, along with alleviation of pain and improvement in difficulty sitting[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne major consideration in posterior spinal fusion for NMS is whether to extend the instrumentation caudally to include the pelvis. In patients with significant pelvic obliquity or severe spinal imbalance (commonly defined as pelvic obliquity\u0026thinsp;\u0026gt;\u0026thinsp;15\u0026deg;, apex of curvature\u0026thinsp;\u0026lt;\u0026thinsp;L3, and Cobb angle\u0026thinsp;\u0026gt;\u0026thinsp;60\u0026deg;), pelvic fixation can help achieve a more level pelvis and better coronal and sagittal alignment[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, this added procedure increases surgical complexity and has also been associated with longer operative times, greater blood loss, and higher rates of wound and implant-related complications[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The decision to include pelvic fixation therefore remains a long-standing point of debate, with no clear consensus currently established in the literature.\u003c/p\u003e \u003cp\u003eWhile previous studies have investigated the postoperative complications and short-term risks of pelvic fixation[\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], these investigations have largely relied on single-center cohorts, limiting both statistical power and generalizability. In addition, few have directly compared outcomes to non-pelvic fixation cohorts and examined whether these risks persist beyond the early postoperative period, and none have done so at a large scale[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. To date, no study has comprehensively evaluated both short- and long-term postoperative outcomes of pelvic fixation in pediatric NMS using a large, nationally representative dataset. Such an analysis is critical to better inform surgical decision-making and clarify the long-term impact of pelvic fixation.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis was a retrospective cohort study conducted using de-identified electronic health records from the TriNetX Research Network, a federated database that aggregates pre-existing clinical data from 106 health care organizations. The dataset includes diagnoses, procedures, and laboratory values coded using the International Classification of Diseases, Tenth Revision (ICD-10), and Current Procedural Terminology (CPT) codes. All data is de-identified in accordance with Section \u0026sect;\u0026nbsp;164.514(a) of the HIPAA Privacy Rule, and is therefore exempt from informed consent requirements and institutional review board (IRB) approval. The study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCohort Selection\u003c/h3\u003e\n\u003cp\u003eThis study evaluated short- and long-term postoperative complications in adolescents undergoing posterior spinal fusion for neuromuscular scoliosis, comparing outcomes between patients who did and did not receive pelvic fixation. Patients aged\u0026thinsp;\u0026le;\u0026thinsp;21 years who underwent posterior spinal fusion were identified using the following CPT codes: 22800, 22802, and 22804. Pelvic fixation was defined by CPT code 22848 or ICD-10-PCS codes 0SG7 and 0SG8, which capture sacroiliac joint fixation procedures. To define the neuromuscular scoliosis population, we included patients with a diagnosis of NMS and/or related neuromuscular disorders, such as cerebral palsy, spina bifida, and muscular dystrophy.\u003c/p\u003e \u003cp\u003eTo reduce the risk of confounding, patients with congenital or syndromic scoliosis (e.g., Marfan syndrome, Ehlers-Danlos syndrome, neurofibromatosis, and osteogenesis imperfecta) were excluded. Patients with a prior history of deformity surgery were also excluded from the query. A full list of inclusion/exclusion criteria and associated codes are detailed in Supplementary Table\u0026nbsp;1, and a schematic overview of cohort selection is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003e1:1 Propensity Matching\u003c/h3\u003e\n\u003cp\u003eTo minimize baseline differences between cohorts and reduce selection bias, the TriNetX platform was used to perform 1:1 propensity score matching using logistic regression. A greedy nearest neighbor algorithm with a caliper of 0.1 pooled standard deviations was applied, ensuring that matched pairs had a maximum allowable difference in propensity scores of \u0026le;\u0026thinsp;0.1.\u003c/p\u003e \u003cp\u003eAll variables used for matching were collected up to and including the date of the index surgery, ensuring that only preoperative characteristics were used to avoid post-exposure bias. Matching variables included demographic characteristics, relevant comorbidities, and intraoperative variables such as number of vertebral levels fused and use of instrumentation. Crucially, we also matched on the underlying neuromuscular diagnosis to ensure comparability in disease etiology.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003ePostoperative outcomes were assessed across two distinct follow-up periods: a short-term window defined as 1 to 365 days following the index surgery, and a long-term window beginning at 365 days postoperatively and extending through the most recent available follow-up at the time of query. The data query encompassed a 20-year period, allowing for both short- and long-term complications to be comprehensively assessed through the most up-to-date clinical records available.\u003c/p\u003e \u003cp\u003eAll outcomes were defined using standardized ICD-10 and CPT codes, and included surgical site infection, any infection (including deep infections and those related to orthopedic devices, implants, or grafts), wound breakdown, device failure, sepsis, reduced mobility, pseudarthrosis, removal of hardware or graft, additional instrumentation, and revision surgery. Revision surgery was defined broadly and included any return to the operating room related to the index procedure, encompassing removal of hardware or graft, insertion of new devices, and other reoperations. A full list of postoperative outcomes and their associated codes is provided in Supplementary Table\u0026nbsp;2.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eBefore matching, the cohort included 918 patients who underwent pelvic fixation and 1,412 patients who did not. Following 1:1 matching, 534 matched pairs remained for analysis. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, all covariates were successfully reduced to standardized mean differences less than 0.1, indicating appropriate balance between groups and successful mitigation of selection bias.\u003c/p\u003e \u003cp\u003eWithin the first year following surgery, patients who underwent pelvic fixation experienced significantly higher rates of several postoperative complications compared to matched controls (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Surgical site infection occurred in 35 (6.6%) of pelvic fixation cases versus 12 (2.3%) of controls (RR 2.92, 95% CI 1.53\u0026ndash;5.56, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while wound breakdown was observed in 66 (12.4%) versus 33 (6.2%) of patients, respectively (RR 2.00, 95% CI 1.34\u0026ndash;2.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Rates of any postoperative infection\u0026mdash;whether superficial or deep as well as infections related to internal orthopedic devices, implants, or grafts\u0026mdash;were also elevated in the pelvic fixation group (54 [10.1%] vs. 31 [5.8%]; RR 1.74, 95% CI 1.14\u0026ndash;2.66, p\u0026thinsp;=\u0026thinsp;0.009).\u003c/p\u003e \u003cp\u003eIn contrast, no statistically significant differences were observed between groups during the long-term follow-up period beginning 365 postoperatively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, outcomes that were highly significant in the short term showed convergence over time, with no significant differences observed in the long-term window (wound breakdown: RR 1.10, p\u0026thinsp;=\u0026thinsp;0.753; any infection: RR 1.46, p\u0026thinsp;=\u0026thinsp;0.141; SSI: RR 1.00, p\u0026thinsp;=\u0026thinsp;1.000).\u003c/p\u003e \u003cp\u003eNotably, there were no significant differences between groups in key orthopedic hardware-related complications during either the short-term (1\u0026ndash;365 days) or long-term (\u0026ge;\u0026thinsp;365 days) follow-up periods. Device failure occurred in 10 (1.9%) of patients in both groups during the first year (RR 1.00, p\u0026thinsp;=\u0026thinsp;1.000), and in 13 (2.4%) of pelvic fixation patients versus 10 (1.9%) of controls in the long term (RR 1.30, p\u0026thinsp;=\u0026thinsp;0.527). Rates of additional instrumentation were 12 (2.3%) vs. 13 (2.4%) in the short term (RR 0.92, p\u0026thinsp;=\u0026thinsp;0.840) and 12 (2.3%) vs. 19 (3.6%) in the long term (RR 0.63, p\u0026thinsp;=\u0026thinsp;0.202). Revision surgery was performed in 16 (3.0%) of pelvic fixation patients versus 18 (3.4%) of controls in the short term (RR 0.89, p\u0026thinsp;=\u0026thinsp;0.727), and in 15 (2.8%) vs. 22 (4.1%) in the long term (RR 0.68, p\u0026thinsp;=\u0026thinsp;0.241). Pseudarthrosis occurred in 47 (8.8%) of pelvic fixation patients compared to 56 (10.5%) of controls within the first year (RR 0.84, p\u0026thinsp;=\u0026thinsp;0.351), and in 52 (9.7%) vs. 48 (9.0%) beyond one year (RR 1.08, p\u0026thinsp;=\u0026thinsp;0.674). Removal of hardware occurred in 10 (1.9%) of patients in both groups in the short term (RR 1.00, p\u0026thinsp;=\u0026thinsp;1.000) and in 11 (2.1%) vs. 14 (2.6%) in the long term (RR 0.79, p\u0026thinsp;=\u0026thinsp;0.544).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTo our knowledge, this is the first multicenter database study to compare both short- and long-term outcomes in pediatric patients undergoing posterior spinal fusion for NMS with and without pelvic fixation. Using a large, nationally representative dataset and propensity-matched cohorts, we found that pelvic fixation was associated with significantly higher rates of short-term complications, including surgical site infection, wound breakdown, and overall infection. After the first postoperative year, however, all outcomes\u0026mdash;including both soft tissue and hardware-related complications\u0026mdash;were comparable between groups.\u003c/p\u003e \u003cp\u003eWe defined long-term follow-up as beginning at 365 days postoperatively, based on the typical timeline for bone fusion, wound healing, and resolution of early inflammatory responses[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This threshold also reflects the biology of spinal arthrodesis, which unfolds over distinct phases and continues well beyond the initial postoperative period\u003csup\u003e29\u003c/sup\u003e. Diagnosing pseudarthrosis before 12 months may therefore be premature, as incomplete remodeling and delayed graft incorporation can mimic nonunion during this period. Defining our window in this manner also ensures that outcomes classified as \u0026ldquo;long-term\u0026rdquo; truly reflect new or delayed postoperative events rather than misclassified short-term complications that may have persisted.\u003c/p\u003e \u003cp\u003eIn the short term, pelvic fixation was associated with a two- to three-fold increase in the risk of postoperative soft tissue complications compared to the non-pelvic fixation cohort (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Notably, approximately 65% of surgical site infections and 50% of wound breakdowns observed in the pelvic fixation group could be attributed to the fixation. These findings are not unexpected given the increased surgical complexity and extent of dissection required for pelvic fixation[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Various methods of pelvic fixation\u0026mdash;both traditional[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and modern[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u0026mdash;often involve more extensive exposure and additional hardware placement, which can prolong operative time, increase blood loss, and disrupt soft tissue. These factors are well-established contributors to higher rates of postoperative wound complications and infection[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and likely underlie the elevated short-term morbidity observed in our cohort.\u003c/p\u003e \u003cp\u003eOur findings align with several studies comparing early postoperative complications in patients undergoing surgical treatment for NMS with and without pelvic fixation. For example, a 2005 study comparing outcomes in 30 patients undergoing fusion to the sacrum with a unit rod versus 25 patients undergoing fusion to L5 with a U-rod found a slightly higher postoperative superficial infection rate in the pelvic fixation group (6.7%, compared to 4.0% in L5 group)[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. They did not, however, find any significant difference in the rate of deep wound infections (0% for both groups). Similarly, a 2014 retrospective study of 428 patients with neuromuscular scoliosis found that pelvic fixation was independently associated with more than a two-fold increased risk of deep surgical site infection compared to patients without pelvic instrumentation (OR\u0026thinsp;=\u0026thinsp;2.4, p\u0026thinsp;=\u0026thinsp;0.04)[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNotably, wound and infection-related outcomes that were significantly different in the short term showed no statistically significant differences between pelvic and non-pelvic fixation beyond 1 year (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These findings are consistent with previous studies reporting no long-term disadvantage to pelvic fixation. For example, a recent single-institution retrospective study showed no statistical difference in both clinical outcomes and postoperative complications at 2 year follow-up[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Farshad et. al also showed no difference in infection rate (p\u0026thinsp;=\u0026thinsp;1.0) and wound healing (p\u0026thinsp;=\u0026thinsp;0.134) between those fixed to the lumbar spine versus the pelvis, with an average follow-up of 56 months[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These results are expected, as surgical site infections and wound complications are typically early postoperative events, and new infections rarely arise after the soft tissues and surgical site have healed.\u003c/p\u003e \u003cp\u003eMechanical outcomes such as device failure, pseudarthrosis, and revision surgery showed no significant differences between pelvic and non-pelvic fixation groups across both short- and long-term periods. This is particularly notable given that constructs terminating at the pelvis often involve more extensive instrumentation and greater biomechanical demands[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. While our findings generally mirror trends observed in previous studies, reported rates of mechanical failure and revision following pelvic fixation remain highly variable in the literature. For example, one 2022 study reported a 4.3% failure rate within 2 years[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u0026mdash;slightly higher than our 2.4% rate in the long-term window. In contrast, Longstein et al. reported a 14.8% revision rate using the Luque-Galveston technique[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], while a 2019 study found a 17.7% revision rate following spinopelvic fixation with iliac screws[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Notably, some comparative studies report outcomes that differ significantly from ours, showing significantly elevated rates of failure when comparing pelvic fixation to non-pelvic fixation controls. One systematic review reported revision surgery in 14% of patients undergoing pelvic fixation, and 0.8% in those whose fusion terminated at the lumbar spine[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These discrepancies are likely attributable to differences in study design, as well as inconsistent adjustment for comorbidities and a lack of balanced representation of neuromuscular scoliosis etiologies across cohorts.\u003c/p\u003e \u003cp\u003eAlthough our reported rates of pseudarthrosis are relatively high\u0026mdash;8.8% vs. 10.5% (pelvic vs. non-pelvic) within the first year, and 9.7% vs. 9.0% beyond one year\u0026mdash;there were no statistically significant differences between groups during either follow-up period. These findings fall within the broad range of pseudarthrosis rates reported in the literature for patients undergoing deformity surgery for neuromuscular scoliosis, which vary from as low as 2.2%[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] to as high as 22.2%[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The lack of significant difference between groups is not unexpected, as pseudarthrosis is likely influenced by numerous patient-specific and systemic factors\u0026mdash;such as nutritional status, bone quality, and comorbidities\u0026mdash;that may affect fusion rates independently of distal fixation level[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Interestingly, a 2021 case-control study reported a pseudarthrosis rate of 12.4% in patients undergoing long-segment fusion for adult spinal deformity, and identified pelvic fixation as a significant risk factor[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This discrepancy may be explained by differences in study design and population\u0026mdash;namely, the inclusion of all deformity types (not just scoliosis), an adult-only cohort, and the absence of a direct comparison group.\u003c/p\u003e \u003cp\u003eThis study has several limitations inherent to its retrospective design and use of administrative data. First, although we used robust propensity score matching to reduce baseline differences between groups, residual confounding cannot be ruled out. Second, the use of ICD and CPT codes to define diagnoses and complications may result in misclassification or underreporting of certain outcomes. Third, while the long-term follow-up window extended beyond one year, follow-up duration varied between patients, and some complications may have occurred after the data capture period. Additionally, we could not evaluate radiographic outcomes such as fusion rates or implant positioning, which are not captured in the TriNetX database. And lastly, although our cohort included a broad, nationally representative population, findings may not be generalizable to settings with different patient demographics, surgical practices, or resource availability.\u003c/p\u003e \u003cp\u003eFuture studies should aim to incorporate radiographic and functional outcomes, enabling a more comprehensive assessment of fusion integrity and postoperative recovery. Additionally, prospective analyses stratified by NMS etiology may help clarify whether certain subgroups derive greater benefit\u0026mdash;or risk\u0026mdash;from pelvic fixation.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn this multicenter cohort of pediatric spinal fusions for neuromuscular scoliosis, pelvic fixation increased short-term complications but not long-term risk. Notably, rates of mechanical and hardware-related complications\u0026mdash;including device failure, pseudarthrosis, and revision surgery\u0026mdash;did not differ significantly between pelvic and non-pelvic groups on long-term follow-up. These findings suggest that while pelvic fixation may elevate short-term morbidity, these risks do not persist beyond the early postoperative period.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Y.M. and G.I.S. The first draft of the manuscript was written by Y.M., and all authors commented on previous versions of the manuscript. J.B. served as the supervising physician and managing principal investigator. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank all colleagues and mentors at the Renaissance School of Medicine and Department of Orthopedics at Stony Brook University who provided guidance and support throughout the development of this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data used for analysis in this study were obtained from the TriNetX Research Network and are not publicly available due to privacy and data use agreements. However, the de-identified data used for analysis may be made available from the authors upon reasonable request and with appropriate institutional approvals.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBerven S, Bradford DS (2002) Neuromuscular scoliosis: causes of deformity and principles for evaluation and management. Semin Neurol 22:167\u0026ndash;178. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1055/s-2002-36540\u003c/span\u003e\u003cspan address=\"10.1055/s-2002-36540\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoughenbury PR, Tsirikos AI (2022) Current concepts in the treatment of neuromuscular scoliosis: clinical assessment, treatment options, and surgical outcomes. 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Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 30:3225\u0026ndash;3232. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00586-021-06861-w\u003c/span\u003e\u003cspan address=\"10.1007/s00586-021-06861-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eBaseline characteristics of pediatric patients undergoing posterior spinal fusion for neuromuscular scoliosis, before and after propensity score matching.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore Propensity Score Matching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter Propensity Score Matching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic Name\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePelvic Fixation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=918)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-Pelvic Fixation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1412)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePelvic Fixation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=534)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-Pelvic Fixation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=534)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eAge at Index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e13.00 \u0026plusmn; 3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e13.57 \u0026plusmn; 3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e13.16 \u0026plusmn; 3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e13.14 \u0026plusmn; 3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eAmerican Indian or Alaska Native\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (0.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e29 (3.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e51 (3.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e16 (3.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e16 (3.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e139 (15.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e153 (10.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e76 (14.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e73 (13.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e430 (46.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e736 (52.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e253 (47.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e258 (48.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eHispanic or Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e121 (13.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e196 (13.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e71 (13.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e77 (14.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e488 (53.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e672 (47.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e281 (52.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e276 (51.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eNative Hawaiian or Other Pacific Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (0.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eNot Hispanic or Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e748 (81.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e995 (70.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e417 (78.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e414 (77.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e600 (65.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e858 (60.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e337 (63.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e350 (65.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eComorbidities\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eDependence on wheelchair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e391 (42.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e308 (21.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e174 (32.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e184 (34.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e11 (0.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eDisorders of bone density and structure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e262 (28.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e176 (12.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e110 (20.60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e121 (22.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eHypertensive diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e132 (14.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e98 (6.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e49 (9.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e50 (9.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eMalnutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e227 (24.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e173 (12.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e107 (20.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e102 (19.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eOverweight and obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e81 (8.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e98 (6.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e41 (7.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e40 (7.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNeuromuscular Conditions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eCerebral palsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e659 (71.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e628 (44.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e350 (65.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e347 (64.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eFamilial dysautonomia [Riley-Day]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e42 (4.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e19 (1.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e13 (2.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e12 (2.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eMuscular dystrophy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e118 (12.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e136 (9.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e72 (13.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e74 (13.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eNeuromuscular scoliosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e823 (89.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1165 (82.51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e456 (85.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e447 (83.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eSpina bifida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e57 (6.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e136 (9.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e41 (7.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e39 (7.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eSpinal muscular atrophy and related syndromes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e79 (8.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e65 (4.60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e40 (7.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e36 (6.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSelect Procedural Covariates\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eAllograft, morselized, or placement of osteopromotive material, for spine surgery only\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e654 (71.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e975 (69.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e368 (68.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e372 (69.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eAllograft, structural, for spine surgery only\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e106 (7.51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eArthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e858 (93.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e896 (63.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e485 (90.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e482 (90.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eArthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e39 (4.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e422 (29.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e31 (5.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e30 (5.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eArthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e52 (5.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e129 (9.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e33 (6.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e36 (6.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eAutograft for spine surgery only\u003csup\u003eW\u003c/sup\u003e; local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e621 (67.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e854 (60.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e336 (62.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e332 (62.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eAutograft for spine surgery only\u003csup\u003eW\u003c/sup\u003e;\u0026nbsp;morselized (through separate skin or fascial incision)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e101 (11.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e49 (3.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e32 (5.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e32 (5.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eAutograft for spine surgery only\u003csup\u003eW\u003c/sup\u003e\u003csup\u003e;\u0026nbsp;\u003c/sup\u003estructural, bicortical or tricortical (through separate skin or fascial incision)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e11 (0.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eBone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e16 (1.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e62 (4.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e15 (2.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e15 (2.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003ePosterior segmental instrumentation\u003csup\u003eF\u003c/sup\u003e; 3 to 6 vertebral segments\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e54 (3.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e11 (2.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003ePosterior segmental instrumentation\u003csup\u003eF\u003c/sup\u003e; 7 to 12 vertebral segments\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e19 (2.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e375 (26.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e19 (3.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e23 (4.31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003ePosterior segmental instrumentation\u003csup\u003eF\u003c/sup\u003e;13 or more vertebral segments\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e868 (94.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e855 (60.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e484 (90.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e482 (90.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003csup\u003eW\u003c/sup\u003e(includes harvesting the graft)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003eF\u003c/sup\u003e(eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eShort-term postoperative complication rates (1\u0026ndash;365 days) in pediatric patients undergoing posterior spinal fusion with and without pelvic fixation.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk (n=534)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePelvic Fixation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNon-Pelvic Fixation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRisk Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSurgical Site Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (6.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (2.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.53, 5.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWound Breakdown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66 (12.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33 (6.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.34, 2.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAny Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54 (10.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31 (5.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.14, 2.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eReduced Mobility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e145 (27.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e118 (22.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.99, 1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33 (6.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30 (5.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.68, 1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRemoval of Hardware/Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.42, 2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDevice Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.42, 2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAdditional Instrumentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (2.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (2.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.43, 2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRevision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (3.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (3.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.46, 1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePseudarthrosis/Nonunion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (8.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56 (10.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.58, 1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eLong-term postoperative complication rates (\u0026ge;365 days) in pediatric patients undergoing posterior spinal fusion with and without pelvic fixation.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk (n=534)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePelvic Fixation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNon-Pelvic Fixation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRisk Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAny Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (6.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24 (4.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.88, 2.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDevice Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (2.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (1.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.58, 2.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWound Breakdown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22 (4.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (3.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.61, 1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePseudarthrosis/Nonunion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52 (9.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48 (8.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.75, 1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSurgical Site Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (2.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (2.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.48, 2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eReduced Mobility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e194 (36.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e199 (37.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.83, 1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72 (13.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75 (14.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.71, 1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRemoval of Hardware/Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (2.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (2.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.36, 1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRevision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (2.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22 (4.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.36, 1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAdditional Instrumentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (2.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19 (3.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.31, 1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pelvic fixation, neuromuscular scoliosis, scoliosis, pediatric spinal fusion, pediatric spine, pediatric deformity","lastPublishedDoi":"10.21203/rs.3.rs-6857170/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6857170/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003ePelvic 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cohort study was conducted using the TriNetX Research Network. Pediatric patients (\u0026le;\u0026thinsp;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\u0026ndash;365 days) and long-term (\u0026ge;\u0026thinsp;365 days).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePelvic 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\u0026mdash;such as device failure, pseudarthrosis, revision surgery, and additional instrumentation\u0026mdash;were similar between groups during both follow-up periods.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePelvic 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.\u003c/p\u003e","manuscriptTitle":"Pelvic fixation in pediatric spinal fusion for neuromuscular scoliosis is associated with increased short-term complications but no long-term risk","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 08:47:41","doi":"10.21203/rs.3.rs-6857170/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"abc708eb-9a37-461a-a35d-04333499f401","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-05T21:08:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-18 08:47:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6857170","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6857170","identity":"rs-6857170","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}