{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:55:33Z","timestamp":1790999733305,"version":"4.1.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Intraoperative navigation is increasingly used in spinal deformity surgery. However, evidence comparing navigated and conventional fluoroscopic-assisted posterior fusion in adolescent idiopathic scoliosis is still heterogeneous and often lacks comprehensive perioperative and recovery data. The aim of this study was to retrospectively compare clinical, radiographic, and perioperative outcomes between CT-navigated and fluoroscopic-assisted posterior spinal fusion in adolescent idiopathic scoliosis (AIS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed 71 patients (54 female, 17 male) with AIS treated between 2011 and 2018. Surgical indication was a structural curve with a Cobb angle\u2009\u2265\u200945\u201350\u00b0. 37 patients underwent navigated fusion (Nav+), and 34 had conventional fluoroscopic-assisted fusion (Nav\u2013). Outcome parameters included Cobb angle correction, operative time, intraoperative blood loss, fluoroscopy time, surgical complications, need for intensive care, hospital stay, and revision rates. Statistical analyses used nonparametric (Mann\u2013Whitney, Chi-square) tests, with significance at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Preoperative Cobb angle was 70.27\u00b0 (SD 18.84\u00b0, range 45\u2013120\u00b0) in Nav\u2009+\u2009and 68.24\u00b0 (SD 20.88\u00b0, range 45\u2013118\u00b0) in Nav\u2013. Mean number of fused segments was higher in Nav+ (10.24\u2009\u00b1\u20091.77; range 7\u201314) compared to Nav\u2013 (9.26\u2009\u00b1\u20092.67; range 4\u201314). Cobb correction did not differ significantly (24.5\u00b0 vs. 24.7\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.85). Operative time was longer in Nav+ (230 vs. 175\u00a0min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0006). ICU admission was more frequent in Nav+ (73% vs. 32.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0006). Hospital stay was shorter in Nav+ (10 vs. 13 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CT-navigation did not improve radiographic correction in AIS. CT-based navigation achieved radiographic correction comparable to fluoroscopic-assisted posterior spinal fusion in AIS. Navigation was associated with longer operative time. Differences in ICU utilization and hospital stay should be interpreted cautiously because they may reflect institutional practice patterns, temporal changes during the study period, surgeon-dependent treatment allocation, and differences in surgical complexity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>III, retrospective study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-026-10393-6","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:46:15Z","timestamp":1790999175000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of navigation and fluoroscopic assisted posterior spinal fusion in adolescent idiopathic scoliosis surgery"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3326-6716","authenticated-orcid":false,"given":"Michael","family":"Sarter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Bay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Lenz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"Kernich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnan","family":"Sircar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peer","family":"Eysel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavros","family":"Oikonomidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"10393_CR1","doi-asserted-by":"publisher","DOI":"10.5704\/MOJ.1711.011","author":"IS Komang-Agung","year":"2017","unstructured":"Komang-Agung IS, Dwi-Purnomo SB, Susilowati A (2017) Prevalence rate of adolescent idiopathic scoliosis: Results of school-based screening in surabaya, Indonesia. Malays Orthop J. https:\/\/doi.org\/10.5704\/MOJ.1711.011. 11:","journal-title":"Malays Orthop J"},{"key":"10393_CR2","doi-asserted-by":"publisher","unstructured":"Penha PJ, Ramos NLJP, De Carvalho BKG et al (2018) Prevalence of adolescent idiopathic scoliosis in the state of S\u00e3o Paulo, Brazil. Spine (Phila Pa 1976) 43. https:\/\/doi.org\/10.1097\/BRS.0000000000002725","DOI":"10.1097\/BRS.0000000000002725"},{"key":"10393_CR3","doi-asserted-by":"crossref","unstructured":"Tarrant RC, Queally JM, Moore DP, Kiely PJ (2018) Prevalence and impact of low body mass index on outcomes in patients with adolescent idiopathic scoliosis: a systematic review. Eur J Clin Nutr 72(11):1463-1484","DOI":"10.1038\/s41430-018-0095-0"},{"key":"10393_CR4","doi-asserted-by":"publisher","unstructured":"Weinstein SL, Dolan LA, Wright JG, Dobbs MB (2013) Effects of Bracing in Adolescents with Idiopathic Scoliosis. N Engl J Med 369. https:\/\/doi.org\/10.1056\/nejmoa1307337","DOI":"10.1056\/nejmoa1307337"},{"key":"10393_CR5","doi-asserted-by":"publisher","unstructured":"Dolan LA, Donzelli S, Zaina F et al (2020) Adolescent Idiopathic Scoliosis Bracing Success Is Influenced by Time in Brace: Comparative Effectiveness Analysis of BrAIST and ISICO Cohorts. Spine (Phila Pa 1976) 45. https:\/\/doi.org\/10.1097\/BRS.0000000000003506","DOI":"10.1097\/BRS.0000000000003506"},{"key":"10393_CR6","doi-asserted-by":"publisher","unstructured":"Heyer JH, Baldwin KD, Shah AS, Flynn JM (2022) Benchmarking surgical indications for adolescent idiopathic scoliosis across time, region, and patient population: a study of 4229 cases. Spine Deform 10. https:\/\/doi.org\/10.1007\/s43390-022-00480-1","DOI":"10.1007\/s43390-022-00480-1"},{"key":"10393_CR7","doi-asserted-by":"publisher","unstructured":"von Heideken J, Iversen MD, Gerdhem P (2018) Rapidly increasing incidence in scoliosis surgery over 14 years in a nationwide sample. Eur Spine J 27. https:\/\/doi.org\/10.1007\/s00586-017-5346-6","DOI":"10.1007\/s00586-017-5346-6"},{"key":"10393_CR8","doi-asserted-by":"crossref","unstructured":"Merloz P, Tonetti J, Pittet L et al (1998) Pedicle screw placement using image guided techniques. In: Clinical Orthopaedics and Related Research","DOI":"10.1097\/00003086-199809000-00006"},{"key":"10393_CR9","doi-asserted-by":"crossref","unstructured":"Holly LT, Foley KT (2007) Image Guidance in Spine Surgery. Orthopedic Clinics of North America 38","DOI":"10.1016\/j.ocl.2007.04.001"},{"key":"10393_CR10","doi-asserted-by":"publisher","unstructured":"Laine T, Lund T, Ylikoski M et al (2000) Accuracy of pedicle screw insertion with and without computer assistance: A randomised controlled clinical study in 100 consecutive patients. Eur Spine J 9. https:\/\/doi.org\/10.1007\/s005860000146","DOI":"10.1007\/s005860000146"},{"key":"10393_CR11","doi-asserted-by":"publisher","unstructured":"Rajasekaran S, Vidyadhara S, Ramesh P, Shetty AP (2007) Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976) 32. https:\/\/doi.org\/10.1097\/01.brs.0000252094.64857.ab","DOI":"10.1097\/01.brs.0000252094.64857.ab"},{"key":"10393_CR12","doi-asserted-by":"crossref","unstructured":"Verma R, Krishan S, Haendlmayer K, Mohsen A (2010) Functional outcome of computer-assisted spinal pedicle screw placement: A systematic review and meta-analysis of 23 studies including 5,992 pedicle screws. Eur Spine J 19(3):370\u2013375","DOI":"10.1007\/s00586-009-1258-4"},{"key":"10393_CR13","doi-asserted-by":"publisher","unstructured":"Hott JS, Theodore N, Klopfenstein JD et al (2004) Image guidance in spinal surgery for trauma: Iso-C 3D. Operative Techniques in Neurosurgery 7. https:\/\/doi.org\/10.1053\/j.otns.2004.04.003","DOI":"10.1053\/j.otns.2004.04.003"},{"key":"10393_CR14","doi-asserted-by":"publisher","unstructured":"Gebhard F, Weidner A, Liener UC et al (2004) Navigation at the spine. Injury 35. https:\/\/doi.org\/10.1016\/j.injury.2004.05.009","DOI":"10.1016\/j.injury.2004.05.009"},{"key":"10393_CR15","doi-asserted-by":"crossref","unstructured":"Holly LT, Foley KT (2003) Intraoperative spinal navigation. Spine (Phila Pa 1976) 28","DOI":"10.1097\/01.BRS.0000076899.78522.D9"},{"key":"10393_CR16","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318238bbd9","author":"E Ughwanogho","year":"2012","unstructured":"Ughwanogho E, Patel NM, Baldwin KD et al (2012) Computed tomography-guided navigation of thoracic pedicle screws for adolescent idiopathic scoliosis results in more accurate placement and less screw removal. Spine (Phila Pa 1976). https:\/\/doi.org\/10.1097\/BRS.0b013e318238bbd9. 37:","journal-title":"Spine (Phila Pa 1976)"},{"key":"10393_CR17","doi-asserted-by":"crossref","unstructured":"Baldwin KD, Kadiyala M, Talwar D et al (2022) Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis. Spine Deform 10(1):19\u201329","DOI":"10.1007\/s43390-021-00385-5"},{"key":"10393_CR18","doi-asserted-by":"crossref","unstructured":"Gelalis ID, Paschos NK, Pakos EE et al (2012) Accuracy of pedicle screw placement: A systematic review of prospective in vivo studies comparing free hand,fluoroscopy guidance and navigation techniques. Eur Spine J 21(2):247\u2013255","DOI":"10.1007\/s00586-011-2011-3"},{"key":"10393_CR19","doi-asserted-by":"publisher","DOI":"10.1007\/s43390-025-01140-w","author":"V Chan","year":"2025","unstructured":"Chan V, Etigunta S, Gausper A et al (2025) Navigation is associated with lower risk of neurological injury and transfusion in pediatric idiopathic scoliosis surgery. Spine Deform. https:\/\/doi.org\/10.1007\/s43390-025-01140-w","journal-title":"Spine Deform"},{"key":"10393_CR20","doi-asserted-by":"publisher","unstructured":"Kelley BV, Hsiue PP, Upfill-Brown AM et al (2021) Utilization trends and outcomes of computer-assisted navigation in spine fusion in the United States. Spine J 21. https:\/\/doi.org\/10.1016\/j.spinee.2021.03.029","DOI":"10.1016\/j.spinee.2021.03.029"},{"key":"10393_CR21","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1396430","author":"M Kraus","year":"2014","unstructured":"Kraus M, Weiskopf J, Dreyhaupt J et al (2014) Computer-aided surgery does not increase the accuracy of dorsal pedicle screw placement in the thoracic and lumbar spine: A retrospective analysis of 2,003 pedicle screws in a level i trauma center. Global Spine J. https:\/\/doi.org\/10.1055\/s-0034-1396430. 5:","journal-title":"Global Spine J"},{"key":"10393_CR22","doi-asserted-by":"publisher","unstructured":"Wagner SC, Morrissey PB, Kaye ID et al (2018) Intraoperative pedicle screw navigation does not significantly affect complication rates after spine surgery. J Clin Neurosci 47. https:\/\/doi.org\/10.1016\/j.jocn.2017.09.024","DOI":"10.1016\/j.jocn.2017.09.024"},{"key":"10393_CR23","doi-asserted-by":"publisher","first-page":"1957","DOI":"10.1177\/21925682241274373","volume":"15","author":"A Singh","year":"2025","unstructured":"Singh A, Kotzur T, Peterson B et al (2025) Computer Assisted Navigation Does Not Improve Outcomes in Posterior Fusion for Adolescent Idiopathic Scoliosis. Global Spine J 15:1957\u20131965. https:\/\/doi.org\/10.1177\/21925682241274373","journal-title":"Global Spine J"},{"key":"10393_CR24","doi-asserted-by":"publisher","unstructured":"Urbanski W, Jurasz W, Wolanczyk M et al (2018) Increased radiation but no benefits in pedicle screw accuracy with navigation versus a freehand technique in scoliosis surgery. Clin Orthop Relat Res 476. https:\/\/doi.org\/10.1007\/s11999.0000000000000204","DOI":"10.1007\/s11999.0000000000000204"},{"key":"10393_CR25","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1007\/s43390-025-01054-7","volume":"13","author":"AP Lloyd","year":"2025","unstructured":"Lloyd AP, Jin H, McKay G et al (2025) A single-centre early experience of the PulseTM navigation system for posterior spinal fusion in adolescent idiopathic scoliosis (AIS). Spine Deform 13:1161\u20131167. https:\/\/doi.org\/10.1007\/s43390-025-01054-7","journal-title":"Spine Deform"},{"key":"10393_CR26","doi-asserted-by":"publisher","unstructured":"Striano BM, Crawford AM, Verhofste BP et al (2024) Intraoperative navigation increases the projected lifetime cancer risk in patients undergoing surgery for adolescent idiopathic scoliosis. Spine J 24. https:\/\/doi.org\/10.1016\/j.spinee.2024.01.007","DOI":"10.1016\/j.spinee.2024.01.007"},{"key":"10393_CR27","doi-asserted-by":"publisher","unstructured":"Sakai Y, Matsuyama Y, Nakamura H et al (2008) Segmental pedicle screwing for idiopathic scoliosis using computer-assisted surgery. J Spinal Disord Tech 21. https:\/\/doi.org\/10.1097\/BSD.0b013e318074d388","DOI":"10.1097\/BSD.0b013e318074d388"},{"key":"10393_CR28","doi-asserted-by":"publisher","unstructured":"Linden GS, Ghessese S, Cook D, Hedequist DJ (2022) Pedicle Screw Placement in Adolescent Idiopathic Scoliosis: A Comparison between Robotics Coupled with Navigation versus the Freehand Technique. Sensors 22. https:\/\/doi.org\/10.3390\/s22145204","DOI":"10.3390\/s22145204"},{"key":"10393_CR29","doi-asserted-by":"crossref","unstructured":"\u0141ajczak P, Ayesha A, Jabbar R et al (2025) Comparison of accuracy of pedicle screw placement for adolescent idiopathic scoliosis using freehand fluoroscopic, navigation, and robotic-assisted techniques - a systematic review and bayesian network meta-analysis. Neurosurg Rev 48(1):257","DOI":"10.1007\/s10143-025-03333-3"},{"key":"10393_CR30","doi-asserted-by":"publisher","unstructured":"Moore HG, Samuel AM, Burroughs PJ et al (2021) Use of intraoperative navigation for posterior spinal fusion in adolescent idiopathic scoliosis surgery is safe to consider. Spine Deform 9. https:\/\/doi.org\/10.1007\/s43390-020-00218-x","DOI":"10.1007\/s43390-020-00218-x"},{"key":"10393_CR31","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1007\/s43390-024-00879-y","volume":"12","author":"AO Al-Naseem","year":"2024","unstructured":"Al-Naseem AO, Al-Muhannadi A, Ramadhan M et al (2024) Robot-assisted pedicle screw insertion versus navigation-based and freehand techniques for posterior spinal fusion in scoliosis: a systematic review and meta-analysis. Spine Deform 12:1203\u20131215","journal-title":"Spine Deform"},{"key":"10393_CR32","doi-asserted-by":"publisher","unstructured":"Lim KBL, Yeo ISX, Ng SWL et al (2023) The machine-vision image guided surgery system reduces fluoroscopy time, ionizing radiation and intraoperative blood loss in posterior spinal fusion for scoliosis. Eur Spine J 32. https:\/\/doi.org\/10.1007\/s00586-023-07848-5","DOI":"10.1007\/s00586-023-07848-5"},{"key":"10393_CR33","doi-asserted-by":"publisher","first-page":"1957","DOI":"10.1177\/21925682241274373","volume":"15","author":"A Singh","year":"2025","unstructured":"Singh A, Kotzur T, Peterson B et al (2025) Computer Assisted Navigation Does Not Improve Outcomes in Posterior Fusion for Adolescent Idiopathic Scoliosis. Global Spine J 15:1957\u20131965. https:\/\/doi.org\/10.1177\/21925682241274373","journal-title":"Global Spine J"},{"key":"10393_CR34","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1016\/j.jspd.2018.11.012","volume":"7","author":"FJ Baky","year":"2019","unstructured":"Baky FJ, Milbrandt T, Echternacht S et al (2019) Intraoperative Computed Tomography\u2013Guided Navigation for Pediatric Spine Patients Reduced Return to Operating Room for Screw Malposition Compared With Freehand\/Fluoroscopic Techniques. Spine Deform 7:577\u2013581. https:\/\/doi.org\/10.1016\/j.jspd.2018.11.012","journal-title":"Spine Deform"},{"key":"10393_CR35","doi-asserted-by":"publisher","unstructured":"Berlin C, Quante M, Thomsen B et al (2021) Intraoperative Radiation Exposure for Patients with Double-Curve Idiopathic Scoliosis in Freehand-Technique in Comparison to Fluoroscopic- And CT-Based Navigation. https:\/\/doi.org\/10.1055\/a-1121-8033. Z Orthop Unfall 159:","DOI":"10.1055\/a-1121-8033"},{"key":"10393_CR36","doi-asserted-by":"publisher","unstructured":"Shan LQ, Skaggs DL, Lee C et al (2013) Intensive care unit versus hospital floor: A comparative study of postoperative management of patients with adolescent idiopathic scoliosis. J Bone Joint Surg 95. https:\/\/doi.org\/10.2106\/JBJS.L.00467","DOI":"10.2106\/JBJS.L.00467"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-026-10393-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-026-10393-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-026-10393-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:46:17Z","timestamp":1790999177000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-026-10393-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,3]]},"references-count":36,"alternative-id":["10393"],"URL":"https:\/\/doi.org\/10.1007\/s00586-026-10393-6","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,3]]},"assertion":[{"value":"19 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 September 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 October 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}