Navigation is associated with lower risk of neurological injury and transfusion in pediatric idiopathic scoliosis surgery

Abstract

Background: Spinal navigation has been shown to improve accuracy with pedicle screw placement and reduce complications in adult spine patients. It remains understudied in the pediatric spine population. Purpose: The purpose of this study was to assess the impact of spinal navigation on rates of neurological injury, allogeneic transfusion, and reoperation in pediatric idiopathic scoliosis. Methods: This was a retrospective cohort study using the NSQIP pediatric database, years 2016–2022. Patients were included in this study if they were under 18 years of age and received posterior spinal fusion with seven or more surgical levels for idiopathic scoliosis. Anterior approaches were excluded from the study. The study cohort was divided into (1) no navigation cohort and (2) navigation cohort. The primary outcome was rate of postoperative neurological injury. Secondary outcomes were 30 day reoperation, allogeneic blood transfusion, and operative time. Rates of neurological injury, reoperation, and allogeneic transfusion were compared using Chi-square test. Operative time was compared using Student’s T test. Logistic regression analyses were performed to determine the association between use of spinal navigation and the outcomes of interest. Results: There were 22,384 patients included in this study. Mean age was 14.4 years. Spinal navigation was used in 1879 (8.4%). Spinal navigation was associated with a reduced rate of postoperative neurological injury (no navigation: 1.2% vs. navigation: 0.6%, p = 0.02). The navigation cohort had a lower rate of allogeneic transfusion (no navigation: 12.2% vs. navigation: 8.4%, p < 0.001). There was no difference in 30 day reoperation rate (no navigation: 1.4% vs. navigation: 1.5%, p = 0.56). The navigation cohort had longer operative time (no navigation: 4.6 h vs. navigation: 5.0 h, p < 0.001). In the multivariable regression analysis, use of spinal navigation was associated with reduced odds of postoperative neurological injury (OR = 0.51, p = 0.03) and allogeneic transfusion (OR = 0.68, p < 0.001). Conclusion: Spinal navigation was associated with significantly decreased rates of postoperative neurological injury and allogeneic transfusion in pediatric idiopathic scoliosis surgery, with an average of 0.4 h longer operative time.