Journal of the Pediatric Orthopaedic Society of North America · 2025
Navigating the Curve: The Rising Use of Intraoperative Navigation in Posterior Spinal Fusion for Early-onset Scoliosis in the United States.
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Koschmeder Katelyn T, Haglin Jack M, Zeller Amy M, Karlen Judson W, Bennett David M
Аннотация
BACKGROUND: Intraoperative navigation has advanced spine surgery, but its use in pediatric posterior spinal fusion (PSF) for early-onset scoliosis (EOS) is not well described. We aimed to evaluate national trends in intraoperative navigation utilization for this population.
METHODS: We conducted a retrospective cohort study using the PearlDiver database, identifying patients under 10 years of age who underwent PSF for EOS from 2010 to 2023. Procedures were identified using Current Procedural Terminology (CPT) codes for PSF, with CPT 61783 denoting cases involving stereotactic computer-assisted navigation. Patients aged 10 years or older were excluded. Annual proportions of navigation use were calculated, and surgeon specialty and insurance status were recorded. Categorical variables were reported as frequencies and percentages and continuous variables as means ± standard deviation. Annual trends and differences in navigation use by surgeon specialty and insurance status were assessed using inferential statistics including chi-squared test, with a P value <.05 considered significant.
RESULTS: A total of 3,121 patients (mean age: 7.8 ± 1.3 years; 67.6% female) underwent PSF for EOS during the study period. Navigation was used in 476 cases (15.3%), with utilization rising from 0% in 2010 to 38.0% in 2023. Of all cases, orthopaedic surgeons performed 88.7% and neurosurgeons 11.3%. However, neurosurgeons used navigation more frequently (24.4% of their cases) than orthopaedic surgeons (14.1%; P = .037). Navigation-assisted PSF was more common among commercially insured patients (82.8%) than among patients without commercial insurance (72.7%), suggesting a disparity in access (P < .01).
CONCLUSIONS: Intraoperative navigation use in pediatric PSF for EOS has increased substantially over the past decade. This technology was utilized more frequently in cases performed by neurosurgeons than by orthopaedic surgeons, and among commercially insured patients than those without commercial insurance, suggesting a disparity in access (P < .01). These trends underscore the broader integration of navigation in pediatric spine surgery and highlight potential disparities based on provider and insurance status. Further studies should assess the effects of navigation on surgical outcomes and long-term benefits in this vulnerable population.
KEY CONCEPTS: (1)Early-onset scoliosis: Early-onset scoliosis (EOS) represents a challenging pediatric spinal deformity, for which posterior spinal fusion (PSF) remains an important surgical option.(2)Posterior spinal fusion: Trends over the past decade show a rising use of intraoperative navigation in PSF for EOS, reflecting broader integration of technology into pediatric spine surgery.(3)Intraoperative navigation: Our analysis demonstrates that neurosurgeons use navigation more frequently than orthopaedic surgeons, suggesting potential differences in adoption across specialties.(4)Healthcare disparities: Children with commercial insurance were more likely to receive navigation-assisted procedures, highlighting an unequal access to advanced intraoperative technologies.(5)Pediatric spine surgery: These findings emphasize the need for orthopaedic surgeons to consider both the clinical advantages and the systemic barriers when evaluating navigation in pediatric spine surgery.
LEVEL OF EVIDENCE: Level III.
METHODS: We conducted a retrospective cohort study using the PearlDiver database, identifying patients under 10 years of age who underwent PSF for EOS from 2010 to 2023. Procedures were identified using Current Procedural Terminology (CPT) codes for PSF, with CPT 61783 denoting cases involving stereotactic computer-assisted navigation. Patients aged 10 years or older were excluded. Annual proportions of navigation use were calculated, and surgeon specialty and insurance status were recorded. Categorical variables were reported as frequencies and percentages and continuous variables as means ± standard deviation. Annual trends and differences in navigation use by surgeon specialty and insurance status were assessed using inferential statistics including chi-squared test, with a P value <.05 considered significant.
RESULTS: A total of 3,121 patients (mean age: 7.8 ± 1.3 years; 67.6% female) underwent PSF for EOS during the study period. Navigation was used in 476 cases (15.3%), with utilization rising from 0% in 2010 to 38.0% in 2023. Of all cases, orthopaedic surgeons performed 88.7% and neurosurgeons 11.3%. However, neurosurgeons used navigation more frequently (24.4% of their cases) than orthopaedic surgeons (14.1%; P = .037). Navigation-assisted PSF was more common among commercially insured patients (82.8%) than among patients without commercial insurance (72.7%), suggesting a disparity in access (P < .01).
CONCLUSIONS: Intraoperative navigation use in pediatric PSF for EOS has increased substantially over the past decade. This technology was utilized more frequently in cases performed by neurosurgeons than by orthopaedic surgeons, and among commercially insured patients than those without commercial insurance, suggesting a disparity in access (P < .01). These trends underscore the broader integration of navigation in pediatric spine surgery and highlight potential disparities based on provider and insurance status. Further studies should assess the effects of navigation on surgical outcomes and long-term benefits in this vulnerable population.
KEY CONCEPTS: (1)Early-onset scoliosis: Early-onset scoliosis (EOS) represents a challenging pediatric spinal deformity, for which posterior spinal fusion (PSF) remains an important surgical option.(2)Posterior spinal fusion: Trends over the past decade show a rising use of intraoperative navigation in PSF for EOS, reflecting broader integration of technology into pediatric spine surgery.(3)Intraoperative navigation: Our analysis demonstrates that neurosurgeons use navigation more frequently than orthopaedic surgeons, suggesting potential differences in adoption across specialties.(4)Healthcare disparities: Children with commercial insurance were more likely to receive navigation-assisted procedures, highlighting an unequal access to advanced intraoperative technologies.(5)Pediatric spine surgery: These findings emphasize the need for orthopaedic surgeons to consider both the clinical advantages and the systemic barriers when evaluating navigation in pediatric spine surgery.
LEVEL OF EVIDENCE: Level III.