Time cost of the intraoperative CT in dorsal spinal fusion surgery in degenerative spinal disorders - a retrospective analysis of 518 degenerative cases.

Introduction: To evaluate the impact of intraoperative CT (ioCT)-based navigation on surgery duration, non-surgical anesthesia time, and postoperative length of stay in posterior spinal fusion procedures for degenerative spinal disorders, while accounting for surgeon performance and other procedural factors. Research question: Does the intraoperative CT use prolong the surgery, and does it affect short term recovery. Materials and methods: This retrospective, single-center study analyzed 518 cases of dorsal spinal fusion performed with or without ioCT between 2013 and 2018 for degenerative spinal disorders. Demographic and clinical variables such as the number of screws implanted, use of cages, revision status and the surgical volume of the performing surgeon. Surgery duration and postoperative length of stay were assessed using generalized linear models (GLMs). Results: The mean age of the cohort was 65.67 years (52.5 % female). ioCT-based navigation was employed in 209 of 518 cases (40.3 %). After multivariable adjustment, ioCT increased skin-to-skin time by 38.1 min in the full cohort. The effect persisted in both prespecified subgroups, adding 39.2 min in complex procedures (≥6 screws, ≥4 cages, or iliac screws; n = 233) and 40.2 min in non-complex procedures (n = 285). High-volume surgeons (>50 cases) shortened operative time by ≈ 35 min ioCT showed no significant influence on postoperative length of stay. Discussion and conclusion: Intraoperative CT-based navigation modestly increases surgical and procedural time. IoCT use did not affect postoperative hospital stay in our analysis, neither improving the short term outcome through better accuracy nor worsening the outcomes through the effects of prolonged surgery time.