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

Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has become increasingly popular due to reduced tissue trauma, decreased blood loss, and faster recovery compared to traditional open procedures. The integration of 3D CT-based intraoperative navigation has significantly enhanced surgical precision and workflow optimization, potentially leading to better outcomes. However, workflow optimization has not been qualitatively or quantitatively assessed in MIS TLIF, and there may be an increase in setup and waiting times between surgeries in exchange for improved precision. In this retrospective study at a tertiary spine center, 44 patients undergoing fully navigated MIS TLIF were evaluated. A total of 176 pedicle screws were inserted using a sequential, navigation-guided workflow tailored to TLIF and decompression. Surgical accuracy, functional outcomes, perioperative safety, and workflow efficiency were assessed. The findings revealed significant improvements in Oswestry disability index (ODI) and numerical rating scale (NRS) scores, minimal blood loss, short operative times, and high screw placement precision (6.81% Grade 1 breaches). This article supports the clinical reliability and reproducibility of a fully navigated O-arm-assisted MIS TLIF protocol, offering qualitative evidence of improved workflow not previously reported.