Chan Vivien, Etigunta Suhas, Gausper Adeesya, Liu Andy M, Illingworth Kenneth D, Hogue Grant D, Hedequist Daniel J, Skaggs David L
Cedars Sinai Spine, Cedars Sinai Medical Center, 444 S San Vicente Blvd, Ste 900, Los Angeles, CA, 90048, USA.
Boston Children's Hospital, Harvard University, Boston, MA, USA.
Spine Deform. 2025 Jun 29. doi: 10.1007/s43390-025-01140-w.
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.
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.
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.
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).
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.
脊柱导航已被证明可提高椎弓根螺钉置入的准确性，并减少成年脊柱患者的并发症。在儿童脊柱人群中，这方面的研究仍较少。
本研究的目的是评估脊柱导航对小儿特发性脊柱侧凸患者神经损伤发生率、异体输血率和再次手术率的影响。
这是一项回顾性队列研究，使用2016 - 2022年的NSQIP儿科数据库。纳入本研究的患者年龄在18岁以下，因特发性脊柱侧凸接受了七个或更多手术节段的后路脊柱融合术。前路手术被排除在研究之外。研究队列分为（1）无导航队列和（2）导航队列。主要结局是术后神经损伤发生率。次要结局是30天再次手术率、异体输血率和手术时间。使用卡方检验比较神经损伤率、再次手术率和异体输血率。使用学生t检验比较手术时间。进行逻辑回归分析以确定脊柱导航的使用与感兴趣的结局之间的关联。
本研究共纳入22384例患者。平均年龄为14.4岁。1879例（8.4%）使用了脊柱导航。脊柱导航与术后神经损伤发生率降低相关（无导航：1.2% vs. 导航：0.6%，p = 0.02）。导航队列的异体输血率较低（无导航：12.2% vs. 导航：8.4%，p < 0.001）。30天再次手术率无差异（无导航：1.4% vs. 导航：1.5%，p = 0.56）。导航队列的手术时间更长（无导航：4.6小时 vs. 导航：5.0小时，p < 0.001）。在多变量回归分析中，使用脊柱导航与术后神经损伤几率降低（OR = 0.51，p = 0.03）和异体输血几率降低（OR = 0.68，p < 0.001）相关。
在小儿特发性脊柱侧凸手术中，脊柱导航与术后神经损伤率和异体输血率显著降低相关，手术时间平均延长0.4小时。
