Introduction: Spinal computer-assisted navigation (CAN) is proven to increase instrumentation accuracy. Adoption remains limited by workflow restrictions, learning curves and costs. Here, we assess spinal CAN usage among Ontario surgeons to identify gaps in application, and temporal trends of usage.
Methods: A prospectively-collected database of provincial insurance billables and diagnostic codes was reviewed retrospectively, from 2002-2014. Patients undergoing instrumented spinal fusions or percutaneous vertebroplasty/kyphoplasty were identified. Fee and diagnostic codes were applied to distinguish surgical indication and approach. The use of intra-operative navigation was determined for each case.
Results: We identified 4607 instrumented spinal fusions in our cohort. Most cases were performed by orthopedic surgeons (63.2%) and the remainder by neurosurgeons. Of 2239 cases with identifiable etiology, CAN was utilized in 8.8%, predominantly for trauma and degenerative pathologies rather than deformity. In univariate analyses, CAN was used more often by neurosurgeons (21.0% vs. 12.4%, p<0.001), in academic institutions (15.9% vs. 12.3%, p<0.001), and when performed in/after 2010 (18.9% vs. 8.9%, p<0.001). Differences by specialty and year remained significant in multiple logistic regression.
Conclusions: Spinal CAN has proven benefit for instrumentation accuracy, but is used preferentially by academic neurosurgeons. Significant gains must be made in cost and usability to improve access across disciplines and institutions.
Patient Care: This research identifies the spatial and temporal usage patterns of spinal intra-operative neuronavigation, a tool which is proven to increase accuracy and safety but is not commonly adopted due to concerns over cost, workflow and efficiency, among others. This study identifies real-world consequences of these shortcomings, and pinpoints regions/expertise which may be targeted in the development of future navigation technologies, to improve translation and adoption of this effective but underutilized tool.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Identify the spatial and temporal trends in navigation usage for spinal procedures in a single-province cohort in Canada
2) Identify shortcomings in navigation technology leading to gaps in usage, with the goal of improving the development of future navigation techniques to address these translational gaps