Abstract
BACKGROUND CONTEXT Neurologic injury is a complication of significant consequence in adult spinal deformity (ASD) cases, and developing practices to minimize complications remains of great interest. Computer-assisted navigation (CAN) and intraoperative neuromonitoring (ION) are potentially helpful tools in ASD surgery, but evidence of their effectiveness in reducing neurologic complication rates remains limited. PURPOSE (1) Evaluate trends in the use of CAN and ION for ASD surgery in the United States; (2) Assess the risk of neurological injury with CAN and ION. STUDY DESIGN/SETTING Retrospective longitudinal analysis of the MarketScan® national administrative claims database (2007-2015). PATIENT SAMPLE Using ICD-9 and CPT codes, we identified patients >18yrs with an ASD diagnosis that underwent a related surgical procedure that involved at least 3 levels of fusion and/or instrumentation and had continuous health plan enrollment for the period studied were included. OUTCOME MEASURES Annual rates of CAN and ION, complications (neurological, overall) within 90 days, reoperations within 90 days and 2 years. METHODS Patients were categorized into four groups to assess differences in outcome variables: CAN, ION, CAN+ION, and NONE. Univariate differences were assessed with Chi-Squared and Fisher's exact tests. Complication rates were assessed with multivariable logistic regression models adjusting for demographics, comorbidities and surgical details. RESULTS From 2007 to 2015, 21,750 patients had ASD surgery. CAN rates increased from 2.9% in 2007 to 7.3% in 2015 (p CONCLUSIONS CAN and ION are being utilized more frequently in adult spinal deformity correction surgery in the United States. While ION does appear to be associated with a reduction in overall complication rate, the utility of CAN in reducing neurological complication and reoperation rates appears to be limited and warrants further study to inform clinical practice before the adoption of CAN and ION into standard of care. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
Published Version
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