Neurosurgery Resident Westchester Medical Center Valhalla, NY, US
Disclosure(s):
Sabrina L. Zeller, MD: No financial relationships to disclose
Introduction: Intraoperative stereotactic navigation systems (ISNS) are routinely used in spine surgery to enhance precision and improve visualization of relevant anatomy. However, the potential impact of ISNS on postoperative infection remains controversial. This study aims to evaluate the association between ISNS and postoperative infection following posterior or posterolateral spinal fusion.
Methods: We conducted a retrospective analysis of posterior or posterolateral spinal fusion procedures reported from 2016 to 2020 in the NSQIP database. Patients were divided into two groups: those who underwent surgery with ISNS and those without. Baseline demographics including patient age, BMI, comorbidities, operative time, and length of stay were collected. Primary outcomes included reoperation rates, superficial surgical site infection (SSI), deep SSI, sepsis, septic shock, and wound dehiscence. Chi-square tests and logistic regression analysis were conducted for univariate and multivariate analysis, respectively, of baseline demographics and primary outcomes
Results: Mean operative time (241.8 ± 112.5 min vs 189.2 ± 107.2 min, p < 0.0001) and length of stay (4.6 ± 9.1 days vs 3.5 ± 7.5 days, p < 0.0001) were significantly longer for the navigation group than for the non-navigation group. Controlling for patient age, length of stay, operative time, and frailty, navigation-assisted posterior or posterolateral spinal fusion was associated with significantly decreased odds of reoperation (p=0.01) and significantly greater odds of superficial SSI (p=0.02), deep SSI (p=0.04), and all postoperative infections (p=0.009) within 30 days of index procedure.
Conclusion : The use of navigation systems in posterior or posterolateral spinal fusion procedures is associated with a decreased rate of reoperation but increased rates of postoperative infection. These findings highlight the complex relationship between navigation and surgical outcomes, creating a cost versus benefit decision model and demonstrating the need for further research to optimize use and improve patient safety.
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