Computer-assisted surgical navigation is associated with an increased risk of neurological complications: a review of 67,264 posterolateral lumbar fusion cases

Ajiboye, Remi M.; Koltsov, Jayme; Karamian, Brian A.; Swinford, Steven T.; Montgomery, Blake K.; Arzeno, Alexander; Ziino, Chason; Cheng, Ivan

doi:10.21037/jss.2019.09.21

Cited by 7 publications

(5 citation statements)

References 29 publications

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“… 20 , 21 Prior studies have shown equal rates of revisions and complications between robotically assisted and freehand pedicle screw insertion. 8 , 18 , 22 , 23 Taken together, these findings suggest the touted benefits of robotically assisted pedicle screw fixation may not translate clinically for patients, corroborating the findings of our study. On both univariate and regression analysis, no difference was found for any clinical outcome measures between freehand vs robotically assisted pedicle screw insertion.…”

Section: Discussionsupporting

confidence: 87%

“…When examining the literature, previous studies demonstrate disparate similar results regarding complication and revision rates between robotic vs freehand pedicle screw placement. 8,18,22,23 In a retrospective study of 520 lumbar fusion cases, no differences were observed in the rate of postoperative complications between robotically assisted vs freehand pedicle screw placement. 23 These results have been corroborated by multiple randomized controlled trials for lumbar fusion, which demonstrate no differences in rates of complications or revisions between patients in the robotic arm vs the freehand arm.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of Robotic Versus Freehand Pedicle Screw Placement After One-to Three-Level Lumbar Fusion

Karamian

DiMaria

Sawires

et al. 2021

Global Spine Journal

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Study Design Retrospective cohort study Objectives The purpose of this study is to compare patient-reported outcome measures (PROMs) for patients undergoing one-to three-level lumbar fusion using robotically assisted vs freehand pedicle screw placement. Methods Patients who underwent either robotically assisted or freehand pedicle screw placement for one-to three-level lumbar fusion surgery from January 1, 2014 to August 31, 2020 at a single academic institution were identified. Propensity score matching was performed based on demographic variables. Clinical and surgical outcomes were compared between groups. Recovery Ratios (RR) and the proportion of patients achieving the minimally clinically important difference (%MCID) were calculated for Oswestry Disability Index, PCS-12, MCS-12, VAS Back, and VAS Leg at 1 year. Surgical outcomes included complication and revision rates. Results A total of 262 patients were included in the study (85 robotic and 177 freehand). No significant differences were found in ΔPROM scores, RR, or MCID between patients who underwent robotically assisted vs freehand screw placement. The rates of revision (1.70% freehand vs 1.18% robotic, P = 1.000) and complications (.57% freehand vs 1.18% robotic, P = .546) were not found to be statically different between the 2 groups. Controlling for demographic factors, procedure type (robotic vs freehand) did not emerge as a significant predictor of ΔPROM scores on multivariate linear regression analysis. Conclusions Robotically assisted pedicle screw placement did not result in significantly improved clinical or surgical outcomes compared to conventional freehand screw placement for patients undergoing one-to three-level lumbar fusion.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Robotic Versus Freehand Pedicle Screw Placement After One-to Three-Level Lumbar Fusion

Karamian

DiMaria

Sawires

et al. 2021

Global Spine Journal

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“…This method allows surgeons to visualize spinal anatomy not typically exposed during instrumentation to facilitate optimal positioning of screws. [10][11][12][13] Previous studies have demonstrated decreased rates of pedicle screw breaches with NAV, perhaps leading to its increasing popularity. 10,14 However, while a systematic review noted a significant decrease in breach rates during SF for AIS with NAV compared to the traditional free-hand method, the same study failed to demonstrate an impact on complication rates.…”

mentioning

confidence: 99%

“…Computer-assisted navigation (NAV) involves intraoperative use of three-dimensional imaging and optical trackers to guide screw placement. This method allows surgeons to visualize spinal anatomy not typically exposed during instrumentation to facilitate optimal positioning of screws 10–13 . Previous studies have demonstrated decreased rates of pedicle screw breaches with NAV, perhaps leading to its increasing popularity 10,14 .…”

mentioning

confidence: 99%

Does Navigation Make Spinal Fusion for Adolescent Idiopathic Scoliosis Safer? Insights From a National Database

Kaur

Koltsov²,

Kwong³

et al. 2021

Spine

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Study Design. Retrospective Cohort. Objective. To evaluate the effect of computer-assisted navigation (NAV) on rates of complications and reoperations after spinal fusion (SF) for adolescent idiopathic scoliosis (AIS) using a nationally representative claims database. Summary of Background Data. Significant controversy surrounds the reported benefits of NAV in SF for AIS. Previous studies have demonstrated decreased rates of pedicle screw breaches with NAV compared to free-hand methods but no impact on complication rates. Thus, the clinical utility of NAV remains uncertain. Methods. Analyses were performed using the IBM MarketScan databases. Patients aged 10 to 18 undergoing SF for AIS were grouped by use of NAV. Patients with nonidiopathic scoliosis were excluded. Univariate and risk-adjusted multivariate analyses were performed. Primary outcomes were neurological complications, any medical complications, and reoperations. Secondary outcomes included adjusted total reimbursements and length of stay. Results. A total of 12,046 patients undergoing SF for AIS were identified, and 8640 had 90-day follow-up. NAV was used in 467 patients (5.4%), increasing from 2007 to 2015. After risk adjustment, the odds for any complication within 90 days were lower with NAV (OR ¼ 0.61, P ¼ 0.025), but neurological complications were unrelated to NAV (P ¼ 0.742). NAV was not associated with reoperation within 90 days (P ¼ 0.757) or 2 years (P ¼ 0.095). We observed a $25,038 increase in adjusted total reimbursements (P < 0.001) and a 0.32-day decrease in length of stay (P ¼ 0.022) with use of NAV. Conclusion. In this national sample, NAV was associated with a lower rate of total complications but no change in rates of neurological complications or reoperations. In addition, NAV was associated with a large increase in total payments, despite a modest decrease in hospital stay. Considering the increasing popularity of NAV, this study provides important context regarding the utility of NAV for AIS.

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“…32 Care must be taken to pay close attention to anatomic landmarks with the use of neuronavigation; loss of stereotactic fidelity can lead to hardware malposition. 33,34 Additionally, when utilizing neuronavigation for the OLIF approach, cage placement should begin at the level farthest away from the reference frame and proceed caudally towards the frame. Cage placement generates some movement of the spine, which impacts the accuracy of the navigation most greatly in regions distal to the frame.…”

mentioning

confidence: 99%

Commentary: Oblique Lumbar Interbody Fusion From L2 to S1: 2-Dimensional Operative Video

Saadeh

Strong

Muhlestein

et al. 2021

ONSURG

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Computer-assisted surgical navigation is associated with an increased risk of neurological complications: a review of 67,264 posterolateral lumbar fusion cases

Cited by 7 publications

References 29 publications

Clinical Outcomes of Robotic Versus Freehand Pedicle Screw Placement After One-to Three-Level Lumbar Fusion

Clinical Outcomes of Robotic Versus Freehand Pedicle Screw Placement After One-to Three-Level Lumbar Fusion

Does Navigation Make Spinal Fusion for Adolescent Idiopathic Scoliosis Safer? Insights From a National Database

Commentary: Oblique Lumbar Interbody Fusion From L2 to S1: 2-Dimensional Operative Video

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