Utilization trends and outcomes of computer-assisted navigation in spine fusion in the United States

Kelley, Benjamin; Hsiue, Peter P.; Upfill‐Brown, Alexander; Chen, Clark J.; Villalpando, Cristina; Lord, Elizabeth L.; Shamie, Arya Nick; Stavrakis, Alexandra I.; Park, Don Y.

doi:10.1016/j.spinee.2021.03.029

Cited by 12 publications

(16 citation statements)

References 23 publications

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“…Further, the average total charges to the patients who received computer-aided navigation was greater than those without computer-aided navigation use by upwards of $10,000 ( P =0.349). Although not presently significant, this increase in cost mirrors those seen in computer-aided navigation-associated procedures for both knee replacement ($6000, P <0.001) and spinal fusion ($8000, P <0.001) surgeries compared with noncomputer aided navigation operations 7,8. This increase in cost needs to be considered with its supposed benefit.…”

Section: Discussionmentioning

confidence: 88%

“…These similarities in readmission rates and length of stay indicate that computer-aided navigation use in PCF surgeries is not statistically significant. The current literature with respect to length of stay in orthopedic-based operations is ambiguous 8,9,12,13. Our study thus highlights the necessity of further research to elucidate the aid of computer-aided navigation in improving surgical outcomes.…”

Section: Discussionmentioning

confidence: 88%

“…Technological advancements in the field of orthopedics have seen continual growth in recent decades. One such advancement, computer-assisted navigation, has observed increased use in multiple orthopedic subspecialties including spine surgery 7,8. With its ability to assist in anatomical mapping and instrumentation guidance, computer-aided navigation is proving to be an important real-time additive in orthopedic and neurosurgical procedures 6.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Computer-Assisted Navigation on Charges and Readmission in Patients Undergoing Posterior Cervical Fusion Surgery

Tang

Dominy

Arvind

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Objective: The aim was to evaluate cost and outcomes associated with navigation use on posterior cervical fusion (PCF) surgery patients.Summary of Background Data: Computer-assisted navigation systems demonstrate comparable outcomes with hardware placement and procedural speed compared with traditional techniques. Innovations in technology continue to improve surgeons' performance in complicated procedures, causing need to analyze the impact on patient care. Methods:The 2016 NRD was queried for patients with PCF surgery ICD-10 codes. Cost and readmission rates were compared with and without navigation. Nonelective cases and patients below 18 years of age were excluded. Univariate analysis on demographics, surgical data, and total charges was performed. Lastly, multivariate analysis was performed to assess navigation's impact on cost and postoperative outcomes.Results: A total of 11,834 patients were identified, with 137 (1.2%) patients undergoing surgery with navigation and 11,697 (98.8%) patients without. Average total charge was $131,939.47 and $141,270.1 for the non-navigation and navigation cohorts, respectively (P = 0.349). Thirty-day and 90-day readmission rates were not significantly lower in patients who received navigation versus those that did not (P = 0.087). This remained insignificant after adjusting for several variables, age above 65, sex, medicare status, mental health history, and comorbidities. The model adjusting for demographic and comorbidities maintained insignificant results of navigation being associated with decreased 30-day and 90-day readmissions (P = 0.079).Conclusions: Navigation use in PCF surgery was not associated with increased cost, and patients operated on with navigation did not significantly have increased routine discharge or decreased 90-day readmission. As a result, future studies must continue to evaluate the cost-benefit of navigation use for cervical fusion surgery.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of Computer-Assisted Navigation on Charges and Readmission in Patients Undergoing Posterior Cervical Fusion Surgery

Tang

Dominy

Arvind

et al. 2022

Clinical Spine Surgery: A Spine Publication

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“…The serial numbers of each level were marked according to the puncture sequence. In each lumbar level, 16 serial numbers [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] were marked. The technical parameters, such as fluoroscopy time, puncture time, and overall time taken for puncture and localization, as well as the number of fluoroscopies, puncture attempts, and success rate of the first puncture, were recorded for each method according to the lumbar levels and serial numbers.…”

Section: Study Methodsmentioning

confidence: 99%

“…The learning curve for puncture and localization in PELD is steep for junior surgeons (9). In the past decade, C-arm navigation have been increasingly used for pedicle screw placement in spine surgeries which could provide the real-time navigation feedback of depth and angle of pedicle screw placement and have shown significant benefits of higher accuracy, shorter surgery time, and less intraoperative radiation exposure than conventional localization methods (10,11). However, the puncture needle used in PELD cannot be stably connected to the computerassisted navigation adapter.…”

Section: Introductionmentioning

confidence: 99%

Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial

Qin¹,

Deng²,

Lin³

et al. 2021

Ann Transl Med

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Background: Accurate preoperative puncture and localization is a key step in percutaneous endoscopic lumbar discectomy (PELD). This study investigated the benefit of puncture and localization for PELD by C-arm navigation over conventional methods.Methods: Sixteen adult cadavers were randomly divided into two groups (group A defined as the C-arm navigation method, and group B defined as the conventional localization method). Two junior orthopedic surgeons who specialized in spinal surgeries were randomly allocated to each group. Conventional localization using C-arm fluoroscopy and localization using C-arm navigation were performed during the procedure. The intervertebral foramen on both sides at L3-L4, L4-L5, and L5-S1 levels were punctured using the two methods. Technical parameters, such as fluoroscopy time, puncture time, overall time taken for puncture and localization, as well as the number of fluoroscopies, number of puncture attempts, and success rate of the first puncture were compared between the two methods. The learning curves were plotted for the two methods, and correlations between all technical parameters were analyzed.Results: Puncture and localization for PELD assisted by C-arm navigation had a flatter learning curve compared with the conventional localization method. The fluoroscopy, puncture, and total puncturelocalization time for group A were 5.61 (±1.37), 2.29 (±1.22), and 9.78 (±2.66) minutes compared with 15.72 (±3.59), 4.87 (±1.70), and 20.59 (±4.79) minutes for group B, respectively (P<0.05). Fluoroscopy was used on average 5.15 (±1.34) times in group A and 20.04 (±5.05) times in group B (P<0.05). There was an average of 1.08 (±0.28) puncture attempts in group A compared with 4.67 (±1.88) attempts in group B (P<0.05). The success rate of the first puncture was 91.7% in group A and 10.4% in group B (P<0.05).Conclusions: Puncture and localization using C-arm navigation for PELD was shown to dramatically flatten the learning curve of junior surgeons and significantly improved the success rate of the first puncture. Moreover, PELD using C-arm navigation can minimize surgery time and the risk of radiation exposure for both patients and medical staff by reducing the number of fluoroscopies and puncture attempts.

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Anterior cervical osteotomy of diffuse idiopathic skeletal hyperostosis lesions with computer‐assisted navigation surgery: A case report

Avrumova,

Goldman,

Altorfer

et al. 2024

Clinical Case Reports

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Key Clinical MessageDiffuse idiopathic skeletal hyperostosis (DISH) involves spine ligament ossification. Computer‐assisted navigation (CAN) effectively aids complex surgeries, such as anterior cervical osteotomy, to alleviate progressive DISH‐related dysphagia.AbstractWe describe a 68‐year‐old man with sudden onset dysphagia to both solids and liquids. Radiographic Imaging revealed DISH lesions from C2 down to the thoracic spine. The patient was successfully treated with CAN anterior osteotomy and resection of DISH lesions from C3–C6 and had complete symptom relief within 2 weeks post‐operatively.

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Utilization trends and outcomes of computer-assisted navigation in spine fusion in the United States

Cited by 12 publications

References 23 publications

The Impact of Computer-Assisted Navigation on Charges and Readmission in Patients Undergoing Posterior Cervical Fusion Surgery

The Impact of Computer-Assisted Navigation on Charges and Readmission in Patients Undergoing Posterior Cervical Fusion Surgery

Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial

Anterior cervical osteotomy of diffuse idiopathic skeletal hyperostosis lesions with computer‐assisted navigation surgery: A case report

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