European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Comparison of navigation and fluoroscopic assisted posterior spinal fusion in adolescent idiopathic scoliosis surgery.
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Sarter Michael, Bay Carolin, Lenz Maximilian, Kernich Nikolaus, Sircar Krishnan, Eysel Peer, Oikonomidis Stavros
Аннотация
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.
LEVEL OF EVIDENCE: III, retrospective study.
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.
LEVEL OF EVIDENCE: III, retrospective study.