Spinal navigation in the ambulatory surgery center era: a single-center safety and outcomes analysis

OBJECTIVE The volume of spinal surgeries performed in the ambulatory surgery center (ASC) setting continues to increase. This parallels continued growth in minimally invasive spine surgery in which intraoperative navigation offers well-described benefits. However, the use of spinal navigation in the ASC setting has not been well characterized. The aim of this study was to determine how the incorporation of ASC spinal navigation impacts perioperative measures, as well as short- and long-term outcomes, in patients undergoing elective 1- to 2-level spine surgery. METHODS A retrospective analysis was conducted using a prospectively maintained registry of patients undergoing elective 1- to 2-level spine surgery with and without intraoperative navigation and O-arm imaging between March 2019 and August 2025 at a single ASC. Demographic characteristics, comorbidities, and perioperative metrics were collected. Baseline and 1-year postoperative patient-reported outcome measures (PROMs), including the numeric rating scale for back pain and leg pain, Oswestry Disability Index, and EQ-5D, were assessed. Perioperative measures included estimated blood loss (EBL), operative duration, discharge status, inpatient transfer, 90-day readmission, and unplanned return to the operating room. RESULTS Of 280 patients who underwent surgery with navigation, 199 underwent fusion and 81 underwent nonfusion procedures. Of 531 patients who underwent surgery without navigation, 122 underwent fusion and 409 underwent nonfusion procedures. For the fusion cohort, the mean operative duration was 108.14 ± 39.6 minutes in the navigation group compared with 99.49 ± 33.0 minutes in the nonnavigation group (p = 0.044). For the nonfusion cohort, the operative duration was longer in the navigation group compared with the nonnavigation group (74.11 ± 33.6 minutes vs 63.74 ± 23.8 minutes, p = 0.009). For both the nonfusion and fusion cohorts, there was no significant difference in rates of transfer to inpatient, hospital readmission within 90 days, or return to OR within 90 days for the navigation versus nonnavigation groups (p > 0.44 for all). The primary nonfusion procedure type performed with navigation was extraforaminal decompression (56.8% vs 7.1% of nonnavigation group). All PROMs demonstrated significant improvement from baseline to 1 year in both the navigation and nonnavigation groups (p < 0.001 for all). CONCLUSIONS Intraoperative navigation can be safely integrated into the ASC setting without sacrificing efficiency. Favorable perioperative measures, low complication rates, and durable improvements in PROMs support the continued adoption of navigation technology in the outpatient setting.