Highlights from the First Annual Spinal Navigation, Emerging Technologies and Systems Integration Meeting

Navigation for surgical treatment of disorders of the cervical spine - A systematic review

INTRODUCTION

Computer-assisted navigation (CAN) is a well-established tool in spinal instrumentation surgery. Different techniques - each with specific advantages and disadvantages - are used in the cervical spine.

METHODS

A structured summary of different spinal navigation techniques and a review of the literature were done to discuss the advantages and disadvantages of specific navigation tools in the cervical spine.

RESULTS

In cervical spine surgery, CAN increases the accuracy of pedicle screw placement, reduces screw mispositioning and leads to fewer revision surgeries. Due to the mobility of the cervical spine, preoperative CT followed by region matching or intraoperative CT are recommended.

CONCLUSIONS

CAN increases pedicle screw placement accuracy and should be used in spinal instrumentation for the cervical spine whenever possible.

Prevalence of spine surgery navigation techniques and availability in Africa: A cross-sectional study

Background

Africa has a large burden of spine pathology but has limited and insufficient infrastructure to manage these spine disorders. Therefore, we conducted this e-survey to assess the prevalence and identify the determinants of the availability of spine surgery navigation techniques in Africa.

Materials and methods

A two-part questionnaire was disseminated amongst African neurological and orthopedic surgery consultants and trainees from January 24 to February 23, 2021. The Chi-Square, Fisher Exact, and Kruskal-Wallis tests were used to evaluate bivariable relationships, and a p-value <0.05 was considered statistically significant.

Results

We had 113 respondents from all regions of Africa. Most (86.7 %) participants who practiced or trained in public centers and centers had an annual median spine case surgery volume of 200 (IQR = 190) interventions. Fluoroscopy was the most prevalent spine surgery navigation technique (96.5 %), followed by freehand (55.8 %), stereotactic without intraoperative CT scan (31.9 %), robotic with intraoperative CT scan (29.2 %), stereotactic with intraoperative CT scan (8.8 %), and robotic without intraoperative CT scan (6.2 %). Cost of equipment (94.7 %), lack of trained staff to service (63.7 %), or run the equipment (60.2 %) were the most common barriers to the availability of spine instrumentation navigation. In addition, there were significant regional differences in access to trained staff to run and service the equipment (P = 0.001).

Conclusion

There is a need to increase access to more advanced navigation techniques, and we identified the determinants of availability.

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African spine surgery has regional disparities in navigation techniques.

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Fluoroscopy is the most prevalent navigation technique.

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Cost and lack of trained personnel are the most significant barriers.

Unplanned return to the operating room (UPROR) after surgery for adolescent idiopathic scoliosis

STUDY DESIGN

Retrospective analysis of a prospectively collected multi-center database.

PURPOSE

UPROR (Unplanned Return to the Operating Room) is an inclusive metric for unexpected surgery after the index procedure. Given the many quality and safety improvements in AIS surgery over the past 20 years, it is useful for spine deformity surgeons to understand the current rate of UPROR, the etiologies, and trends over time. A report from a very large data set, including multiple surgeons and centers, with longer follow-up, would provide the clearest picture.

METHODS

We performed a retrospective review of a prospective multi-center database of patients who had AIS deformity correction surgery to analyze all cases of UPROR, using linear regression models, survival analysis, and descriptive statistics.

RESULTS

Among 3464 patients who had surgery (ASF, PSF, or ASF + PSF) for AIS from 1995 to 2017, 4.8% had an UPROR event in one of the following categories: surgical-site-related (43.3%), instrument failures (34.3%), revisions (8.4%), neurologic (5.1%), pulmonary (5.1%), medical (0.6%), and other (3.4%). The average time from initial surgery to UPROR was 734.4 days. 45.5% of UPRORs occurred within 1 year, 12.4% between 1 and 2 years, 30.9% between 2 and 5 years, and 11.2% between 5 and 10 years. In patients with at least 2-year, 5-year, and 10-year follow-up, the UPROR rates were 6.6, 7.3, and 9.2%, respectively. Between 1997 and 2013, the UPROR rate decreased by 0.46% per year (95% CI 0.25-0.68, p < 0.001).

CONCLUSION

UPROR has decreased significantly over time but as expected, increases with increased follow-up.

LEVEL OF EVIDENCE

Level III, therapeutic.