Transforming spinal surgery: five years of navigation, workflow optimization and clinical impact

Background: Navigation-assisted spinal instrumentation is increasingly used in modern spine surgery, offering improvements in accuracy, workflow efficiency, and radiation safety. However, real-world implementation and the transition from fluoroscopy to navigation in high-volume trauma centers remain insufficiently described. Methods: This retrospective single-center study reviewed all dorsal spinal instrumentation procedures performed between 2015 and 2025 at a Level I trauma center. A total of 557 patients were analyzed: 119 navigated and 438 fluoroscopic procedures. Demographics, ASA classification, operative time, screw count, radiation parameters, anatomical distribution, and revision rates were compared, with specific focus on changes after the introduction of navigation in 2020. Results: = 0.03). Radiation time was significantly lower in the navigated group, while total dose was comparable. Screw misplacement-related revisions were less frequent with navigation (1% vs. 5%), whereas wound-related revisions were more common, reflecting higher comorbidity and a greater proportion of open procedures. Conclusion: Navigation substantially altered clinical practice, leading to its predominant use in complex anatomies and higher-risk patients. It improved screw accuracy and reduced radiation exposure while maintaining procedural efficiency after the learning curve. With ongoing advances such as robotics, augmented reality, and markerless registration, the role of navigation in spinal trauma surgery is expected to expand further.