Use of Computer Assistance in Lumbar Fusion Surgery: Analysis of 15 222 Patients in the ACS-NSQIP Database

Abstract

Study Design:Retrospective cohort study.Objective:Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of computer-assisted surgery (CAS). Yet few studies have compared the incidence of postoperative complications between CAS and conventional techniques. The objective of this study is to determine the difference in postoperative complication rates between CAS and conventional techniques in spine surgery.Methods:The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent posterior lumbar fusion from 2011 to 2013. Multivariate analysis was conducted to demonstrate the difference in postoperative complication rates between CAS and conventional techniques in spine surgery.Results:Out of 15 222 patients, 14 382 (95.1%) were operated with conventional techniques and 740 (4.90%) were operated with CAS. Multivariate analysis showed that patients in the CAS group had fewer odds to experience adverse events postoperatively (odds ratio [OR] = 0.57, P < .001). Minor adverse events occurred in 2905 (20.2%) patients in the conventional group and in 98 (13.2%) patients in the CAS group (OR = 0.57, P < .001). Blood transfusion was present in 2488 (17.3%) of the patients in the conventional group compared to 81 (11.0%) of the patients in the CAS group (OR = 0.56, P < .001). The mean operative time in the conventional group was 205.2 ± 106.1 minutes, and it was 227.0 ± 111.9 minutes in the CAS group. This difference was statistically significant (r = 20.14, P < .001).Conclusion:This article examined the complications in lumbar spinal surgery with or without the use of CAS. These results suggest that CAS may provide a safer technique for implant placement in lumbar fusion surgeries.

Highlights from the First Annual Spinal Navigation, Emerging Technologies and Systems Integration Meeting

“…This was confirmed in a recently published study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. This study demonstrated fewer adverse events in patients undergoing spinal fusion when computer assisted surgery was used (9). The benefit of navigation systems is specifically pronounced in the thoracic spine (95.5% vs. 79.0% acceptable screw placement) and in scoliotic deformities (10).…”

Deep learning‐based X‐ray inpainting for improving spinal 2D‐3D registration

“…In this example application of pedicle screw fixation surgery, the screws must be precisely positioned within the pedicle structures of each vertebra. Due to the close proximity of these pedicle structures to vital organs such as the spinal cord, accurate assessment of the implant position is of high importance 3 . Despite the introduction of computer‐assisted navigation systems in the past 2 decades, most surgeries are still performed using free‐hand or fluoro‐guided free‐hand approaches.…”

“…Due to the close proximity of these pedicle structures to vital organs such as the spinal cord, accurate assessment of the implant position is of high importance. 3 Despite the introduction of computer-assisted navigation systems in the past 2 decades, most surgeries are still performed using free-hand or fluoro-guided freehand approaches. While several meta-analyses have demonstrated significant improvements in screw insertion accuracy when using computer-assisted navigation compared to the conventional freehand methods, [4][5][6] a world-wide survey in 2013 reported that only 11% of the spine surgeries were performed using navigation systems.…”

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

“…Indeed, RAN has been proved to be a safe technique for spinal decompression, oncologic spine surgery, and MISS including cage positioning. 9,[15][16][17][18] AR is a new promising technology consisting in dedicated software and hardware capable of showing images directly onto special lenses or monitors, hence allowing the surgeon to visualize key information about the patient and the procedure in real time.…”