Michael Sarter, Carolin Bay, Maximilian Lenz, Nikolaus Kernich, Krishnan Sircar, Peer Eysel, Stavros Oikonomidis
{"title":"Comparison of navigation and fluoroscopic assisted posterior spinal fusion in adolescent idiopathic scoliosis surgery.","authors":"Michael Sarter, Carolin Bay, Maximilian Lenz, Nikolaus Kernich, Krishnan Sircar, Peer Eysel, Stavros Oikonomidis","doi":"10.1007/s00586-026-10393-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative navigation is increasingly used in spinal deformity surgery. However, evidence comparing navigated and conventional fluoroscopic-assisted posterior fusion in adolescent idiopathic scoliosis is still heterogeneous and often lacks comprehensive perioperative and recovery data. The aim of this study was to retrospectively compare clinical, radiographic, and perioperative outcomes between CT-navigated and fluoroscopic-assisted posterior spinal fusion in adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>We analyzed 71 patients (54 female, 17 male) with AIS treated between 2011 and 2018. Surgical indication was a structural curve with a Cobb angle ≥ 45-50°. 37 patients underwent navigated fusion (Nav+), and 34 had conventional fluoroscopic-assisted fusion (Nav-). Outcome parameters included Cobb angle correction, operative time, intraoperative blood loss, fluoroscopy time, surgical complications, need for intensive care, hospital stay, and revision rates. Statistical analyses used nonparametric (Mann-Whitney, Chi-square) tests, with significance at p < 0.05.</p><p><strong>Results: </strong>Preoperative Cobb angle was 70.27° (SD 18.84°, range 45-120°) in Nav + and 68.24° (SD 20.88°, range 45-118°) in Nav-. Mean number of fused segments was higher in Nav+ (10.24 ± 1.77; range 7-14) compared to Nav- (9.26 ± 2.67; range 4-14). Cobb correction did not differ significantly (24.5° vs. 24.7°, p = 0.85). Operative time was longer in Nav+ (230 vs. 175 min, p = 0.0006). ICU admission was more frequent in Nav+ (73% vs. 32.4%, p = 0.0006). Hospital stay was shorter in Nav+ (10 vs. 13 days, p < 0.00001).</p><p><strong>Conclusion: </strong>CT-navigation did not improve radiographic correction in AIS. CT-based navigation achieved radiographic correction comparable to fluoroscopic-assisted posterior spinal fusion in AIS. Navigation was associated with longer operative time. Differences in ICU utilization and hospital stay should be interpreted cautiously because they may reflect institutional practice patterns, temporal changes during the study period, surgeon-dependent treatment allocation, and differences in surgical complexity.</p><p><strong>Level of evidence: </strong>III, retrospective study.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00586-026-10393-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Intraoperative navigation is increasingly used in spinal deformity surgery. However, evidence comparing navigated and conventional fluoroscopic-assisted posterior fusion in adolescent idiopathic scoliosis is still heterogeneous and often lacks comprehensive perioperative and recovery data. The aim of this study was to retrospectively compare clinical, radiographic, and perioperative outcomes between CT-navigated and fluoroscopic-assisted posterior spinal fusion in adolescent idiopathic scoliosis (AIS).
Methods: We analyzed 71 patients (54 female, 17 male) with AIS treated between 2011 and 2018. Surgical indication was a structural curve with a Cobb angle ≥ 45-50°. 37 patients underwent navigated fusion (Nav+), and 34 had conventional fluoroscopic-assisted fusion (Nav-). Outcome parameters included Cobb angle correction, operative time, intraoperative blood loss, fluoroscopy time, surgical complications, need for intensive care, hospital stay, and revision rates. Statistical analyses used nonparametric (Mann-Whitney, Chi-square) tests, with significance at p < 0.05.
Results: Preoperative Cobb angle was 70.27° (SD 18.84°, range 45-120°) in Nav + and 68.24° (SD 20.88°, range 45-118°) in Nav-. Mean number of fused segments was higher in Nav+ (10.24 ± 1.77; range 7-14) compared to Nav- (9.26 ± 2.67; range 4-14). Cobb correction did not differ significantly (24.5° vs. 24.7°, p = 0.85). Operative time was longer in Nav+ (230 vs. 175 min, p = 0.0006). ICU admission was more frequent in Nav+ (73% vs. 32.4%, p = 0.0006). Hospital stay was shorter in Nav+ (10 vs. 13 days, p < 0.00001).
Conclusion: CT-navigation did not improve radiographic correction in AIS. CT-based navigation achieved radiographic correction comparable to fluoroscopic-assisted posterior spinal fusion in AIS. Navigation was associated with longer operative time. Differences in ICU utilization and hospital stay should be interpreted cautiously because they may reflect institutional practice patterns, temporal changes during the study period, surgeon-dependent treatment allocation, and differences in surgical complexity.
目的：术中导航在脊柱畸形手术中的应用越来越广泛。然而，比较导航和常规透视辅助下后路融合术治疗青少年特发性脊柱侧凸的证据仍然不一致，而且往往缺乏全面的围手术期和恢复数据。本研究的目的是回顾性比较ct导航和透视辅助下后路脊柱融合术治疗青少年特发性脊柱侧凸（AIS）的临床、影像学和围手术期结果。方法：我们分析了2011年至2018年间治疗的71例AIS患者（女性54例，男性17例）。手术指征为Cobb角≥45-50°的结构曲线。37例患者行导航融合（Nav+）， 34例行常规透视辅助融合（Nav-）。结果参数包括Cobb角矫正、手术时间、术中出血量、透视时间、手术并发症、重症监护需求、住院时间和翻修率。结果：Nav +组术前Cobb角为70.27°（SD 18.84°，范围45-120°），Nav-组术前Cobb角为68.24°（SD 20.88°，范围45-118°）。Nav+组的平均融合节段数（10.24±1.77，范围7-14）高于Nav-组（9.26±2.67，范围4-14）。Cobb校正没有显著差异（24.5°vs. 24.7°，p = 0.85）。Nav+组手术时间更长（230 vs 175 min, p = 0.0006）。Nav+患者入院较多（73% vs. 32.4%, p = 0.0006）。导航组住院时间较短（10天vs. 13天）。结论：ct导航不能改善AIS的影像学矫正。在AIS中，基于ct的导航实现了与透视辅助后路脊柱融合相当的影像学矫正。导航与较长的手术时间相关。ICU使用率和住院时间的差异应谨慎解释，因为它们可能反映了机构实践模式、研究期间的时间变化、外科依赖型治疗分配以及手术复杂性的差异。证据等级：III，回顾性研究。
期刊介绍：
"European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts.
Official publication of EUROSPINE, The Spine Society of Europe
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