Navigation Is Associated With Lower Revision Instrumentation Rates in Pediatric Scoliosis: A Retrospective Review of 15,917 Patients.

Abstract

Navigation-assisted spine surgery has become widely used in adult patients with studies demonstrating improved outcomes. This remains poorly studied in pediatric patients. This study examines the impact of navigation on complication rates in pediatric idiopathic scoliosis surgery. A national insurance database, Pearldiver, a national insurance database with claims from Medicare, private insurance, cash pay, and Medicaid Advantage, identified pediatric patients (<21 y old) with idiopathic scoliosis who underwent posterior spine fusion with ≥2 years of follow-up. Patients were divided into navigated and non-navigated cohorts. A multivariable logistic regression identified risk factors for instrumentation revision, and cohorts were matched 1:2 based on significant variables. The primary outcome was instrumentation revision at 6 months, 2 years, and 10 years postoperatively. Secondary outcomes were postoperative neurological deficit and surgical site infection. Of 15,917 patients, 1599 had navigated and 14,318 had non-navigated surgery. Decreased age and male sex were associated with a revision risk. After cohort matching (4747 total: 1585 navigated, 3162 non-navigated), navigated cases had significantly lower revision rates: 1.1%, 2.7%, and 3.8% vs. 2.1%, 4.4%, and 6.3% (P<0.05). Surgical site infection was significantly lower in navigated cases at 2 years (6.4% vs. 4.2%) and 10 years (8.3% vs. 4.7%) (P<0.001). The overall rate of postoperative neurological deficit was 2.1% and 2.6% for navigated and non-navigated cases (P>0.05). This largest study to date on navigation in pediatric scoliosis surgery demonstrates significantly lower instrumentation revision and infection rates in navigated procedures compared with non-navigated cases. Level III.