We performed a retrospective review study to evaluate the safety and efficacy of iliac screws as a method of pelvic fixation in neuromuscular spinal deformity. All patients with the diagnosis of neuromuscular scoliosis operatively managed with iliac screws undergoing posterior spinal fusion were retrospectively identified over a 32-month period, from December 2002 to August 2005. Evaluation was done for correction of deformity, progression, instrumentation failure, and complications. Progression was defined as an increase in Cobb angle >5 degrees . Of the 14 eligible patients, 12 (86%) had adequate follow-up, with an average final follow-up of 19.5 months (range, 12-39 months). Average patient age at surgery was 15 years. Average number of instrumented levels was 16, with the most common levels being from the second thoracic vertebrae to the sacrum (11/12). A significant correction of deformity from a mean preoperative 66.5 to a mean postoperative 22.8 was achieved. Average postoperative L5-S1 angle was 31 degrees and L1-S1 angle was 61 degrees. At final follow-up, the average L5-S1 angle was 26 degrees and L1-S1 angle was 59 degrees < neither a statistically significant progression (P=.70 and P=.30, respectively). The maximum measured progression was 16 degrees for L5-S1 and 12 degrees for L1-S1. There were no incidences of rod breakage, and there was 1 iliac screw offset connector dislodgement from the rod, which did not require revision. There were no intraoperative complications. There were 3 postoperative wound infections, which required irrigation and debridement and eventually resulted in fusion. In conclusion, this is one of the largest reports of iliac screw use in the correction of neuromuscular scoliosis. In our series we were able to correct the deformity and maintain the lumbar lordosis without progression or failure with a relatively low complication rate.