Introduction: Degenerative thoracolumbar scoliosis is a complex problem often requiring multilevel decompression and long-segment instrumented fusion. Traditional surgical approaches commonly involve laminectomy followed by placement of pedicle screw instrumentation and arthrodesis. This approach can result in significant blood loss and surgical time which may impact outcomes. Three-dimensional image-guided navigation is now available to assist with the placement of spinal instrumentation. Over the last several years we have utilized navigation in the placement of pedicle screws and now place the screws prior to laminectomy. The primary goal of this research was to evaluate the impact of spinal navigation on operative outcomes in complex deformities.
Methods: A retrospective analysis of thoracolumbar deformity surgery involving six or more spinal segments performed by a single surgeon was performed. Data collection included: procedure, age, use of spinal navigation (NAV), use of anti-thrombolytic agents, surgery duration (OP-TIME), estimated blood loss (EBL), staged procedures, need for postoperative mechanical ventilation (PMV), length of hospital stay (LOS), and major perioperative complications. A t-test and chi-square test were performed, followed by multivariate linear regression analysis to evaluate confounding variables.
Results: Ninety-three patients underwent surgery with 49 surgeries utilizing spinal navigation (NAV). The NAV group had shorter OP-TIME (Mean 374 vs. 424 min, P=0.01), lower EBL (Mean 2.4 vs. 3.5L, P=0.01), shorter LOS (6.9 vs 9.5 days, P=0.008), and decreased incidence of PMV (3 vs 12 patients, P=0.02). Non-NAV group held odds ratio for staged procedure compared to NAV group of 10.12, p=0.04. The significance of the findings held in a multivariate analysis adjusting for confounders such as intraoperative use of antithrombolytic agents and performance of pedicle subtraction osteotomy.
Conclusions: This study reveals how intra-operative image-guided navigation for the placement of spinal instrumentation for deformity surgery resulted in decreases in operative time, EBL, need for post-mechanical ventilation and shorter hospital LOS.
Patient Care: Steer spinal surgeons to consider image guidance for placement of instrumentation for safety and improvement in patient outcomes.
Serve to provide evidence in support of hospital(s) to invest in new technology such as this for spinal surgeons.
Contribute to outcomes data research as it well help young and established Neurosurgeons find effective ways to deliver a high level of safe and effective operative care.
Learning Objectives: Use of current technology for safe, efficient, and cost-effective placement of spinal instrumentation.