Complications With Navigation-Assistance in Thoraco-Lumbar Spine Surgery

Complications With Navigation-Assistance in Thoraco-Lumbar Spine Surgery Study design: Narrative review. Objectives: While the use of navigation systems in thoracolumbar spine surgeries has become increasingly popular, few studies exist focusing on the intra- and postoperative complications. The aim was to review the various complications that have been associated with navigation use in the thoraco-lumbar spine and propose surgical techniques to avoid and address associated complications. Methods: We queried the existing literature mentioning complications with navigation-assistance in thoraco-lumbar spine surgery and propose surgical pearls to avoid and address associated complications. Results: A common complication with computer-assisted navigation (CAN) in the thoraco-lumbar spine surgery is technical failures, such as system malfunctions, software glitches, or loss registration. These errors likely contribute to a missed screw rate of up to approximately 10% for screws placed using navigation. Several strategies can be employed to minimize the risk of intraoperative complications, including reference array shifting, excessive bone and soft-tissue pressure, and initial skiving. Although multiple studies have reported a lower rate of pedicle screw-related perioperative complications with CAN, compared to non-navigation procedures, limitations in learning curve and cost-effectiveness still exist. Conclusions: With evolving technology, the navigation system has become increasingly more adaptive in thoracolumbar spine surgery, improving its safety and efficacy. Despite the potential benefits of CAN systems for clinical outcomes, further studies and innovation are required to improve performance to reduce complications and show cost-effectiveness.