Journal of Pediatric Orthopaedics - 2026-01-01 - Journal Article
The Rising Use of Navigation in Pediatric Spine Procedures: Trends and Factors.
Chan V, Etigunta S, Gausper A, Liu AM, Skaggs DL, Illingworth KD, Hogue GD
Topics
Key Takeaway
Navigation use in pediatric posterior spinal fusion increased from 2.0% in 2016 to 15.6% in 2022, with navigated cases showing lower allogeneic transfusion rates but longer operative times.
Summary Depth
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Summary
Using NSQIP Pediatric data (2016–2022), this study characterized navigation adoption trends in pediatric posterior spinal fusion for deformity across 37,594 patients. Navigation was used in 8.6% of cases overall, with higher rates in kyphosis (10.2%), cases with pelvic instrumentation (12.8%), longer constructs (≥13 levels: 9.4%), and pediatric neurosurgery versus orthopaedic surgery (17.7% vs. 8.3%). Navigated cases had lower allogeneic transfusion rates but longer operative times; no difference in postoperative neurological injury or deep SSI was detected.
Key Limitation
NSQIP Pediatric does not capture pedicle screw accuracy, intraoperative fluoroscopy dose, or implant-related revision events, making it impossible to determine whether the transfusion reduction reflects navigation-specific benefits or confounding by case selection.
Original Abstract
BACKGROUND
Spinal navigation has been widely adopted in adult spine surgery. The purpose of this study was to characterize the use of navigation in pediatric spinal deformity surgery.
METHODS
This was a retrospective cohort study. The NSQIP Pediatric database years 2016 to 2022 were used. We included patients 17 years or younger of age that received posterior spinal fusion for deformity. Our primary outcome of interest was the proportion of cases using navigation over time. Our secondary outcomes included the proportion of cases using navigation based on age (under 9 y, 10 to 17 y), etiology (idiopathic scoliosis, neuromuscular scoliosis, syndromic scoliosis, congenital scoliosis, and kyphosis), sex, surgical specialty, number of surgical levels, previous spinal surgery, and pelvic instrumentation. Rates of allogeneic transfusion, postoperative neurological injury, deep surgical site infection, and operative time were compared between the 2 groups over time. Descriptive statistics and χ 2 tests were used for analysis. Adoption curves over time were created for the entire cohort and for each etiology.
RESULTS
There were 37,594 patients in this study. Navigation was used in 3219 (8.6%) cases. The proportion of cases with navigation use has increased from 2016 to 2022 (2016: 2.0% vs. 2022: 15.6%, P <0.001). There was no significant difference in the proportion of cases performed with navigation between patients 9 years or younger and patients 10 to 17 years ( P =0.39). Patients with a diagnosis of kyphosis had a higher rate of navigation use (10.2%, P =0.03). There was a higher rate of navigation use in surgeries with more surgical levels (≤6 levels: 7.5%, 7 to 12 levels: 8.2%, ≥13 levels: 9.4%, P <0.001). There was no significant difference in patients who had previous spinal surgery ( P =0.567). Cases with pelvic instrumentation had a higher rate of navigation use (12.8% vs. 8.1%, P <0.001). Navigation was used in 17.7% of cases performed by pediatric neurosurgery compared with 8.3% of cases performed by pediatric orthopaedic surgery ( P <0.001). Navigated cases had a lower rate of allogeneic transfusion ( P <0.001) and longer operative time ( P <0.001).
CONCLUSION
Use of spinal navigation has increased over time. Several patient and surgical factors are associated with higher rates of navigation use.
LEVEL OF EVIDENCE
Level III.