In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Clinical Outcomes Following Spinal Fusion Using an Intraoperative Computed Tomographic Three-Dimensional Imaging System

    Final Number:
    347

    Authors:
    Roy Xiao BA; Jacob A. Miller BS; Navin C. Sabharwal; Daniel Lubelski MD; Vincent J Alentado MD; Andrew Torre Healy; Thomas Mroz; Edward C. Benzel MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The O-arm Multidimensional Surgical Imaging System provides superior accuracy of pedicle screw insertion compared to free-hand and fluoroscopic approaches. However, no studies have investigated the clinical relevance of increased accuracy. The objective of this study was to investigate the clinical outcomes following spinal fusion using O-arm navigation. We hypothesized that increased accuracy with O-arm navigation decreases the risk of reoperation compared with free-hand and fluoroscopic guidance.

    Methods: A consecutive retrospective review of all patients undergoing non-cervical spinal fusion at a single tertiary-care institution between 12/2012 and 12/2014 was conducted. Multivariable linear and Cox proportional hazards regression were used to investigate the association between O-arm navigation and outcomes.

    Results: Among 1,208 procedures, 614 were performed with O-arm navigation, 356 using free-hand techniques, and 238 using fluoroscopy. The most common indication for surgery was spondylolisthesis (56.2%), and most patients underwent posterolateral fusion (75.7%). The average fusion spanned 4.53 vertebral levels. O-arm patients experienced shorter hospital stays compared to free-hand and fluoroscopy approaches (4.72 days v. 5.07 days, p<0.01), and multivariable linear regression revealed O-arm as an independent predictor of shorter hospital stays compared to fluoroscopy (ß=0.50, p<0.01). O-arm was significantly associated with decreased risk of reoperation for hardware failure (2.9% v. 5.9%, RR 0.50, p=0.01), screw misplacement (1.6% v. 4.2%, RR 0.39, p<0.01), and all-cause reoperation (5.2% v. 10.9%, RR 0.48, p<0.01); these findings were corroborated with Kaplan-Meier survival analysis (Figure 1). Cox proportional hazards modeling revealed that O-arm navigation was an independent predictor of reoperation risk, as free-hand (HR 1.97, p<0.01) and fluoroscopic (HR 2.32, p<0.01) methods both predicted greater risk of reoperation.

    Conclusions: This is the first study to investigate clinical outcomes associated with O-arm navigation following spinal fusion. O-arm navigation predicted decreased length of hospital stay and decreased the risk of reoperation to half the risk of free-hand and fluoroscopic approaches.

    Patient Care: The long-term decreased risk of reoperation associated with O-arm navigation is a critical finding to establish the importance and benefit of intraoperative imaging. The present results suggest that O-arm usage decreases the risk of requiring reoperation by more than half compared to either free-hand of fluoroscopic method; thus, increased use of O-arm navigation could yield significantly improved long-term patient outcomes and represent a cost-effective modality.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of O-arm navigation to improve pedicle screw accuracy and decrease the long-term risk of reoperation. 2) Discuss, in small groups, strategies to further decrease the risk of reoperation in addition to O-arm navigation. 3) Identify an effective treatment of degenerative spine conditions requiring spinal fusion, including approaches using O-arm navigation for superior pedicle screw accuracy.

    References: 1. Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC, et al.: Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 21:247–55, 2012. 2. Shin BJ, James AR, Njoku IU, Härtl R: Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. J Neurosurg Spine 17:113–22, 2012. 3. Oertel MF, Hobart J, Stein M, Schreiber V, Scharbrodt W: Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging. J Neurosurg Spine 14:532–536, 2011.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy