Using Technique and Technology to Improve Safety and Outcomes in AIS: A Review of 12,795 Screws in Pediatric Spine Deformity.

Abstract

Study design: Retrospective Cohort Study.

Objective: This study aimed to compare outcomes in AIS patients that underwent PSF using either freehand with occasional fluoroscopic assistance (FOFA), computer assisted surgery/navigation (CAS), or technique and technology (T&T).

Summary of background data: Pedicle screw insertion in scoliosis is challenging due to abnormal pedicle morphology. Fluoroscopic guidance was frequently utilized, until technological advancements led to the adaptation of computer assisted screw insertion. While improvement in screw accuracy has been documented, an increase in radiation exposure, surgical time, and blood loss can occur. This institution adopted a T&T, or technique and technology, approach that combines freehand technique with CT-based navigation technology for confirmation and navigation for challenging pedicles.

Methods: This was a two-part retrospective review of 573 AIS patients that underwent PSF.Part I: 304 were operated in FOFA. 63 patients were operated on with solely CT-based navigation technology (CAS Group). 206 patients were in T&T. Perioperative outcomes were compared.Part II: 206 T&T patients were compared to 326 AIS patients from the NSQIP database that were operated on using computer-assisted navigation (CAN). Operative time and 30-day complications were compared.All data is presented as medians, IQR, frequencies, and percents. Fisher's Exact, Chi-squared, Kruskal-Wallis, and Wilcoxon rank-sum tests were used.

Results: FOFA radiation dose was 2.3 mGy and radiation time was 20.4 seconds compared to 22.2 mGy and 21.6 seconds for CAS, and 15.0 mGy and 18.6 seconds for T&T (P<0.001, P<0.001). Operative time was shorter for the T&T patients when compared to FOFA and CAS (P<0.001).Part II: T&T had an operative time of 233.0 minutes compared to 323.0 minutes for CAN (P<0.001).

Conclusion: T&T optimizes screw accuracy while reducing the increased radiation burden and operative time associated with CAS. The T&T approach incorporates CT-based navigation technology as confirmation, while maintaining surgeon's skill.