O2088: Balancing Techniques and Technologies to Enhance Safety Measures and Outcomes in the Treatment of AIS

Background: Inserting pedicle screws in scoliosis presents a challenge due to the three-dimensional deformity and abnormal morphology of the pedicle. Surgeons often rely on freehand or fluoroscopic guidance, but advancements in technology have made computer-assisted screw insertion more popular. This technique involves using screen-based guidance rather than tactile feedback. However, this technology may increase surgical time, blood loss, and risk of infection. Furthermore, increased radiation exposure, particularly if a second spin is needed for confirmation after navigation is od greater concern within pediatric populations.

Methods: Retrospective chart review of 529 AIS patients between 2015 and 2020 from a single institution and 356 AIS from NSQIP 2016-2021 database undergoing posterior spinal fusion.

Part I: 151 patients were operated using the freehand technique ‘n’ AIRO technology approach (TNT group). 268 were operated using freehand anatomic and fluoroscopy (Fluoro Group). Radiographic measurements, and clinical outcomes including radiation dose, blood loss, operative time and 30-day complications were compared.

Part II: 151 TNT patients were compared to 356 AIS patients from the NSQIP database that were operated on using computer-assisted navigation between 2012 and 2018 (Navigation Group). Operative time, blood loss and 30-day complications were compared.

All data was presented as mean and frequencies where appropriate. Fisher’s Exact and Kruskal-Wallis tests were used for statistical analysis.

Results: Part I: Average radiation dose for TNT patients was 13.7 mGy compared to 4.6 mGy for the fluoro group (p < 0.001). Average radiation time was 15.3 seconds for the TNT group versus 20.3 seconds for Fluoro (p < 0.001). Operative time was significantly shorter for the TNT patients with an average of 242.0 minutes versus 248.0 minutes (p < 0.001). TNT patients had significantly less blood loss than fluoro patients (300 cc vs 400 cc, p < 0.001). 27 (17.9%) of TNT patients required transfusion compared to 47 (17.5%) Fluoro patients (p = 0.99). Three (1.9%) patients in the TNT group returned within 30-days for superior mesenteric artery syndrome. 8 (2.9%) Fluoro patients returned within 30 days, seven for surgical site infections requiring irrigation and debridement, and one patient returned for postoperative signal loss requiring revision.

Part II: TNT Group had a mean operative time of 242.0 minutes compared to 278.5 for the Navigation group (p < 0.001). 17.3% of Navigation patients were transfused versus 17.9% of TNT patients (p =0.99). The Navigation group had 3(2.7%) returns for 1 surgical site infection, 1 toxic shock syndrome and 1 syncope.

Conclusion: Surgeons should incorporate novel technology that enhances anatomic bone visualization into their techniques while maintaining surgical control. This approach involves adopting technology into the surgical approach rather than restructuring the surgical approach entirely with each innovation, striking a balance between screw accuracy and minimizing surgical time, blood loss, and associated complications.