472 Complications of 3D-Navigated Spinal Procedures: A Systematic Review

INTRODUCTION: 3D surgical navigation has revolutionized spinal surgery. However, information on the overall usability of these tools is limited and inconsistent, especially with regard to operative time and radiation exposure. Complication rates across institutions and platforms have not been systematically examined, leading to a lack of quantitative understanding on surgical success rates. METHODS: This study used PRISMA guidelines and a PROSPERO-registered protocol to identify studies on FDA-approved 3D navigation systems in spinal procedures from Ovid MEDLINE(R), Embase, and Cochrane CENTRAL. Results were assessed by two independent reviewers using inclusion/exclusion criteria and risk of bias tools. RESULTS: 70 studies, totaling 3500 patients, were included. Complication and surgical success rates have remained constant since 2004, with overall rates of 5.18% and 93.74%, respectively. When segmented by spinal region, complication rates may be moderately positively correlated with frequency of cervical and thoracic procedures (r = 0.49, p = 0.40). 23 studies, totaling 1723 patients, compared the performance of 3D navigation to 2D fluoroscopy or freehand navigation. There was a significant difference of 6.47% between surgical success rates of the interventional and control groups (p = 0.01). However, there was no significant difference in radiation exposure or operative time between 3D navigated procedures and their controls. CONCLUSIONS: This study concludes that 3D navigation may have higher surgical success rates than 2D fluoroscopy and freehand navigation; increased surgeon comfort with riskier procedures on more complex segments of the spine may explain the slight increase in complication rates observed since 2004; and there is a need for improvement in 3D navigation tools to decrease operative time and radiation exposure.