• James A Miller and Andrew J Fabiano.
• Department of Neurosurgery, Roswell Park Cancer Institute, Buffalo, New York, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
• World Neurosurg. 2017 Sep 1; 105: 412-419.

ObjectiveSpinal neuronavigation improves accuracy of pedicle screw placement but may increase operative time, and its use in oncologic operations remains relatively unstudied. We compared the use of two-dimensional (2D) fluoroscopy and three-dimensional (3D) spinal neuronavigation relative to operative time in instrumented oncology procedures.MethodsConsecutive instrumented oncologic spinal operations for multiple myeloma or metastatic disease performed between 2012 and 2014 were retrospectively reviewed. Patients were placed in 2 groups based on the method used for pedicle screw placement: 2D fluoroscopy versus spinal neuronavigation with 3D imaging. These groups were compared by age, number of screws placed, number of laminectomy levels, operative time, estimated blood loss, length of hospital stay after surgery, and rate of reoperation as a result of screw misplacement.ResultsFourteen operations used 2D fluoroscopy and 25 used spinal neuronavigation. In the fluoroscopy and neuronavigation groups, respectively, patient ages were 64.71 ± 7.21 years and 63.24 ± 6.95 years (P = 0.534), number of screws was 8.07 ± 1.98 and 7.84 ± 1.34 (P = 0.667), laminectomy levels were 2.18 ± 1.25 and 1.60 ± 1.02 (P = 0.126), operative time was 200.79 ± 34.99 minutes and 193.48 ± 43.77 minutes (P = 0.596), estimated blood loss was 790.00 ± 769.61 mL and 389.80 ± 551.43 mL (P = 0.068), and length of stay after the operation was 7.64 ± 4.63 days and 6.40 ± 3.23 days (P = 0.331). One patient in the 2D fluoroscopy group and no patients in the spinal neuronavigation group required a reoperation for screw misplacement.ConclusionsThere was no significant difference in length of operative time when neuronavigation was compared with fluoroscopy for instrumented oncologic spinal surgery. There was a trend toward a decrease in estimated blood loss in the neuronavigation cases.Copyright © 2017 Elsevier Inc. All rights reserved.

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