Worldwide survey on the use of navigation in spine surgery.

OBJECTIVE Computer-assisted surgery (CAS) can improve the accuracy of screw placement and decrease radiation exposure, yet this is not widely accepted among spine surgeons. The current viewpoint of spine surgeons on navigation in their everyday practice is an important issue that has not been studied. A survey-based study assessed opinions on CAS to describe the current global attitudes of surgeons on the use of navigation in spine surgery. METHODS A 12-item questionnaire focusing on the number and type of surgical cases, the type of equipment available, and general opinions toward CAS was distributed to 3348 AOSpine surgeons (a specialty group within the AO [Arbeitsgemeinschaft für Osteosynthesefragen] Foundation). Latent class analysis was used to investigate the existence of specific groups based on the respondent opinion profiles. RESULTS A response rate of 20% was recorded. Despite a widespread distribution of navigation systems in North America and Europe, only 11% of surgeons use it routinely. High-volume procedure surgeons, neurological surgeons, and surgeons with a busy minimal invasive surgery practice are more likely to use CAS. "Routine users" consider the accuracy, potential of facilitating complex surgery, and reduction in radiation exposure as the main advantages. The lack of equipment, inadequate training, and high costs are the main reasons that "nonusers" do not use CAS. CONCLUSIONS Spine surgeons acknowledge the value of CAS, yet current systems do not meet their expectations in terms of ease of use and integration into the surgical work flow. To increase its use, CAS has to become more cost efficient and scientific data are needed to clarify its potential benefits.