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

Abstract

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.

In idiopathic scoliosis distances of spinal cord to thoracic pedicle are within 2 mm in a large region of the thoracic apex

“…In the past few years, modern intraoperative navigation techniques have been increasingly used for more accurate pedicle screw placement. It has been shown that their use results in a decrease in pedicle breach rates while the effect on neurological complication rates remains debated 17 . Regarding our study’s results showing very small distances between the medial pedicle wall and the spinal cord at the curve’s apex, the use of intraoperative navigation needs to be taken into consideration even more as it allows more accurate screw placement.…”

Introduction of a Novel Sequential Approach to the Ponte Osteotomy to Minimize Spinal Canal Exposure

“…In vivo, our osteotomy techniques are currently performed freehand without any assistance from advanced technology to facilitate bony resections. However, advances in robotics, computer navigation (NAV), and virtual reality (VR) may one day further improve the execution of spinal corrective osteotomies in AIS [ 34 , 35 ]. VR and NAV have been commonly employed to aid in pedicle screw placement, but less has been published about the use of this technology in performing corrective osteotomies.…”

Navigation-Assisted One-Staged Posterior Spinal Fusion Using Pedicle Screw Instrumentation in Adolescent Idiopathic Scoliosis—A Case Series

“…In the past decade, there has been a greater focus on navigation-assisted posterior instrumentation [28,29]. However, few studies have focused on the outcome and complication of navigation-assisted one-stage posterior instrumentation in AIS [30]. As a result, the objective of this study was to evaluate outcomes and complications after navigation-assisted one-stage posterior instrumentation for corrective surgery for AIS.…”