Navigational Assistance in Interbody Device Placement Optimizes Realignment in Adult Spinal Deformity Patients — The International Society for the Study of the Lumbar Spine
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Navigational Assistance in Interbody Device Placement Optimizes Realignment in Adult Spinal Deformity Patients (#1124)

Peter G Passias 1 , Peter S Tretiakov 1 , Tyler K Williamson 1 , Rachel L Joujon-Roche 1 , Bailey T Imbo 1 , Oscar Krol 1 , Shaleen Vira 2 , Bassel Diebo 3 , Stephane Owusu-sarpong 1 , Jordan Lebovic 1 , Renaud Lafage 4 , Virginie Lafage 5 , Dean Chou 6 , Praveen Mummaneni 6 , Paul Park 7 , Saman Shabani 6 , Muhammad Burhan Janjua 8 , Justin S Smith 9 , Andrew J Schoenfeld 10
  1. Department of Orthopaedic Surgery, NYU Langone, New York, NY, United States
  2. UT Southwestern, Dallas
  3. SUNY Downstate, New York
  4. Hospital for Special Surgery, New York
  5. Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
  6. Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
  7. Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan, USA
  8. Department of Neurotrauma, Neuro-oncology, and Spine , Mercy Health , Chicago, IL, USA
  9. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
  10. Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, MA, USA

INTRODUCTION: Minimally-invasive surgery (MIS) and associated robotic or navigational guidance is being increasingly implemented due to its potential to increase surgical accuracy while reducing the risk for complications associated with open spine surgery. However, there remains a paucity in literature as to the patients who may best benefit from MIS surgery in terms of interbody device (IBD) placement.

METHODS: Operative ASD patients undergoing surgery utilizing navigational guidance in IBD placement with pre-(BL) and 1-year(1Y) postop radiographic/HRQL data were included. At 1Y, a favorable outcome was defined as meeting at least 2 of the following 5 criteria: 1) improving in at least 1 GAP or age-adjusted criteria at 1Y 2) achieving ideal PT per SRS-Schwab at 1Y, 3) Achieving ideal PI-LL per SRS-Schwab at 1Y, 4) No adjacent segment reoperation, 5) No complication requiring reoperation. Means comparison analysis assessed differences in radiographic and patient-reported outcomes at BL and 1Y post-op.

RESULTS: 72 MIS patients (59.9±13.1 years, 59.7% female, 28.8±5.5 kg/m2, mean CCI: 0.86±1.215) were included. 20 patients (27.8%) considered optimized. Optimized patients were significantly more likely to be female (p=.013). At BL, optimized patients had a significantly lower S1PI than non-optimized patients (p=.005), as well as lower mean PI-LL (p=.020), and higher L4-S1 lordosis (p=.033). Periooperatively, optimized patients had a higher mean LIV (p=.037), were less likely to undergo ALIF (p=.000), and more likely to undergo LLIF, XLIF, or OLIF (p=.000). Furthermore, optimized patients were less likely to be administered BMP (p=.001). In terms of op time and intraoperative complications, optimized patients experienced significantly higher mean op time (p=.001), yet lower rates of intraoperative complications (p=.000). Optimized patients had a significantly lower mean S1PT than non-optimized patients (p=.038) at 1Y. Additionally, optimized patients had significantly lower 1Y L1PA (p=.021) and L4PA (p=.009). In terms of post-operative complications, optimized patients were significantly less likely to experience post-operative neurological complications (p=.009).

DISCUSSION: Despite increased operative time associated with optimizing IBD placement in MIS patients, such patients demonstrated significantly improved radiographic deformity markers and reduced neurological complication rates by 1Y. 

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