Intraoperative CT for lumbar fusion is not associated with improved short- or long-term complication profiles

BACKGROUND CONTEXT: The use of intraoperative CT has continued to grow in recent years, as various techniques leverage the promise of improved instrumentation accuracy and the hope for decreased complications. Nonetheless, the literature regarding the short-and long-term complications associated with such techniques remains scant and/or confounded by indication and selection bias.PURPOSE: To use causal inference techniques to determine whether intraoperative CT use is associated with an improved complication profile as compared to conventional radiography for single-level lumbar fusions, an increasingly commonplace application for this technology.STUDY DESIGN/SETTING: Inverse probability weighted retrospective cohort study carried out within a large integrated health care network.PATIENT SAMPLE: Adult patients who underwent surgical treatment of spondylolisthesis via lumbar fusion from January 2016 to December 2021.OUTCOME MEASURES: Our primary outcome was the incidence rate of revision surgery. Our secondary outcome was the incidence of composite 90-day complications (deep and superficial sur-gical site infection, venous thromboembolic events, and unplanned readmissions).METHODS: Demographics, intraoperative information, and postoperative complications were abstracted from electronic health records. A propensity score was developed utilizing a parsimoni-ous model to account for covariate interaction with our primary predictor, intraoperative imaging technique. This propensity score was utilized in the creation of inverse probability weights to adjust for indication and selection bias. The rate of revisions within 3 years as well as the rate of revisions at any time-point were compared between cohorts using Cox regression analysis. The incidence of composite 90-day complications were compared using negative binomial regression.RESULTS: Our patient population consisted of 583 patients, with 132 who underwent intraopera-tive CT and 451 who underwent conventional radiographic techniques. There were no significant differences between cohorts following inverse probability weighting. No significant differences were detected in 3-year revision rates (HR, 0.74 [95% CI 0.29, 1.92]; p=.5), overall revision rates (HR, 0.54 [95% CI 0.20, 1.46]; p=.2), or 90-day complications (RC-0.24 [95% CI -1.35, 0.87]; p=.7).CONCLUSIONS: Intraoperative CT use was not associated with an improved complication profile in either the short-or long-term for patients undergoing single-level instrumented fusion. This observed clinical equipoise should be weighed against resource and radiation-related costs when considering intraoperative CT for low complexity fusions. (c) 2023 Elsevier Inc. All rights reserved.

Automated summary

This study compared the complication profiles of intraoperative CT and conventional radiography for single-level lumbar fusions. The results showed that there was no significant improvement in complication rates with the use of intraoperative CT.