Use of intraoperative navigation for posterior spinal fusion in adolescent idiopathic scoliosis surgery is safe to consider.

Abstract

The use of image-guided stereotactic navigation is increasing in use in treating AIS; however, no studies have investigated perioperative outcomes and short-term adverse events compared with non-navigated procedures. The aim of the present study is to use a large national pediatric database to assess the rate of utilization of intraoperative navigation in pediatric patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis (AIS) and to compare thirty-day outcomes of navigated vs. non-navigated surgery. The NSQIP-Pediatric database was queried for cases of posterior fusion for AIS. Patients were stratified by whether or not a concurrent code for stereotactic navigation was used (CPT 61,783). Year of procedure, demographics, comorbidities, operative variables and perioperative adverse outcomes were abstracted and assessed using univariate and multivariate analysis. Overall, 12,739 non-navigated patients and 340 navigated patients were identified. The use of navigation increased from 0.5% of cases in 2012 to 5.2% of cases in 2018. Demographics, comorbidities, and number of levels fused did not differ between navigated and non-navigated patients. Navigated cases were on average 41 min longer than non-navigated cases (268.6 vs. 309.6 min p < 0.001), with 9.84% more cases requiring transfusion (65.0% vs 75.6%, p < 0.001). Hospital stay for navigated cases was an average of 0.4 days shorter (3.9 days vs 4.3 days, p = 0.001). On multivariate analysis, navigated cases had higher odds of prolonged surgery (OR = 2.13, p < 0.001) and lower odds of prolonged length of stay (OR = 0.28, p < 0.001). Although the use of navigation for AIS posterior fusion was associated with longer operative time, post-operative hospital stay was shorter and other perioperative adverse outcomes were not significantly different between groups.