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Utility of Confirmatory Navigational CT Spins in Patients Undergoing One- to Two-Level Instrumented Posterior Fusions
Colson P Tomberlin1, Paul Celestre2, Steven D Glassman2,3
1University of Louisville School of Medicine, Louisville KY 40202.
Spine
|April 21, 2026
Summary
Confirmatory CT scans after lumbar fusion surgery do not improve screw accuracy or reduce reoperation rates. These additional scans increase operative time and radiation exposure, offering minimal clinical benefit.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Fusion Techniques
Background:
- Navigational CT (NavCT) enhances pedicle screw accuracy and reduces blood loss during lumbar fusions.
- Some surgeons utilize an additional confirmatory CT spin post-placement to verify screw trajectory.
- The benefit of confirmatory imaging in routine lumbar fusion remains unclear, despite increased operative time, cost, and radiation exposure.
Purpose of the Study:
- To evaluate the clinical utility of confirmatory Navigational CT (NavCT) spins following pedicle screw placement in posterior lumbar fusions.
- To determine if confirmatory CT scans improve screw accuracy or reduce revision rates in one- to two-level lumbar fusions.
Main Methods:
- Retrospective cohort study of adult patients undergoing one- to two-level posterior instrumented lumbar fusion.
- Patients stratified into three groups: no navigation (NoNav), navigation only (NavCT), and navigation with confirmatory spin (NavCT+C).
- Primary outcomes: intraoperative screw repositioning and return to OR for revision; Secondary outcomes: operative duration, EBL, complications, and one-year follow-up.
Main Results:
- Screw-related complications were rare and did not differ significantly across the three groups (repositioning P=0.683, reoperation P=0.780).
- Confirmatory imaging increased operative time (P=0.01) and radiation exposure without improving screw accuracy or reoperation rates.
- Estimated blood loss (EBL) was significantly lower in NavCT groups compared to NoNav (P < 0.001), but confirmatory scans did not further reduce EBL.
Conclusions:
- Confirmatory NavCT spins offer minimal additional clinical value in one- to two-level lumbar fusions.
- The increased radiation, time, and cost associated with confirmatory imaging outweigh the benefits, as screw accuracy and reoperation rates are not improved.
- Confirmatory imaging should be employed selectively rather than routinely in posterior lumbar fusion procedures.
