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Updated: Jan 12, 2026

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Optimizing Minimally Invasive Spine Surgery: A Fully 3D CT O-Arm Navigated Workflow in MIS TLIF.

Ajay Krishnan¹, Mahesh Sagar², Shivanand Mayi²

¹Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital; drajaykrishnan@gmail.com.

Journal of Visualized Experiments : Jove

|November 3, 2025

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Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) using 3D navigation shows improved patient outcomes and surgical precision. This navigated approach demonstrates clinical reliability and may enhance surgical workflow efficiency in spine surgery.

Area of Science:

Neurosurgery
Orthopedic Surgery
Spine Surgery

Background:

Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) offers benefits over open procedures.
3D CT-based navigation enhances surgical precision in MIS TLIF.
Workflow optimization in navigated MIS TLIF requires assessment.

Purpose of the Study:

To evaluate the clinical reliability and workflow efficiency of a fully navigated O-arm-assisted MIS TLIF protocol.
To assess surgical accuracy, functional outcomes, perioperative safety, and workflow in navigated MIS TLIF.

Main Methods:

Retrospective study of 44 patients undergoing fully navigated MIS TLIF.
Sequential, navigation-guided workflow for TLIF and decompression.
Assessment of surgical accuracy, functional outcomes (ODI, NRS), blood loss, operative time, and screw placement precision.

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Main Results:

Significant improvements in Oswestry disability index (ODI) and numerical rating scale (NRS) scores.
Minimal blood loss and short operative times observed.
High pedicle screw placement precision with 6.81% Grade 1 breaches.

Conclusions:

The fully navigated O-arm-assisted MIS TLIF protocol is clinically reliable and reproducible.
This navigated approach supports improved surgical workflow efficiency.
Navigated MIS TLIF demonstrates potential for better patient outcomes and surgical precision.