Navigation-Assisted Posterior Lumbar Fusion is Associated With Reduced Pseudarthrosis and Subsequent Surgery

Study Design: Retrospective propensity score-matched cohort study using a national federated electronic health record database. Objective: To compare long-term complications following navigation-assisted versus conventional posterior lumbar fusion. Summary of Background Data: Computer-assisted navigation technologies are increasingly used in posterior lumbar fusion to improve pedicle screw placement accuracy and instrumentation reproducibility. However, whether these technical advantages translate into reductions in long-term complications such as pseudarthrosis and reoperation remains uncertain, particularly in large cohorts with extended follow-up. Materials and Methods: The TriNetX Research Network was queried to identify adult patients undergoing posterior lumbar fusion. Navigation-assisted procedures were identified by CPT code 20985 or HCPCS code S2900. Patients were divided into navigation-assisted and conventional cohorts and matched 1:1 using propensity scores. Outcomes assessed included revision fusion, any subsequent spine surgery, nerve root injury, pseudarthrosis, and instrumentation removal. Results: A total of 7268 propensity-matched patients were included. Revision surgery rates were similar at one year but were lower in the computer-assisted cohort at five years (RR: 0.77, P =0.001) and 10 years (RR: 0.75, P <0.001). Navigation-assisted fusion was associated with lower rates of subsequent spine surgery at one year (RR: 0.82, P =0.016), five years (RR: 0.81, P <0.001), and 10 years (RR: 0.79, P <0.001). Nerve root injury occurred less frequently with navigation assistance at all time points (RR: 0.71–0.75). Pseudarthrosis rates were significantly lower with navigation assistance at one year (RR: 0.43), five years (RR: 0.52), and 10 years (RR: 0.53) (all P <0.001). Conclusion: Navigation-assisted posterior lumbar fusion demonstrated associations with lower rates of pseudarthrosis, nerve root injury, and subsequent spine surgery, with reductions in revision fusion emerging over longer-term follow-up.