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Complications With Navigation-Assistance in Thoraco-Lumbar Spine Surgery.

Takeshi Fujii1,2, Patricia Lipson1,3, Kenneth T Nguyen1,4

  • 1Center for Neuroscience and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA, USA.

Global Spine Journal
|February 27, 2026
PubMed
Summary

Computer-assisted navigation (CAN) in thoracolumbar spine surgery can lead to technical failures and missed screws. Strategies exist to minimize complications, but further innovation is needed for improved safety and cost-effectiveness.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Medical Technology

Background:

  • Computer-assisted navigation (CAN) is increasingly utilized in thoracolumbar spine surgeries.
  • Limited research exists on the intra- and postoperative complications associated with CAN in these procedures.

Purpose of the Study:

  • To review complications linked to navigation use in thoracolumbar spine surgery.
  • To propose surgical techniques for avoiding and managing these complications.

Main Methods:

  • A narrative review of existing literature on complications with navigation-assisted thoracolumbar spine surgery.
  • Identification and proposal of surgical pearls to mitigate risks.

Main Results:

  • Common complications include technical failures (system malfunctions, software glitches, registration loss), potentially leading to up to a 10% missed screw rate.
  • Strategies like managing reference array shifting, bone/soft-tissue pressure, and initial skiving can minimize intraoperative risks.
  • While CAN may reduce pedicle screw complications compared to non-navigation methods, learning curve and cost-effectiveness remain challenges.

Conclusions:

  • Navigation systems are becoming more adaptive, enhancing safety and efficacy in thoracolumbar spine surgery.
  • Further research and technological advancements are necessary to further reduce complications and demonstrate cost-effectiveness.