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Overlay of Nerve Roots to Aid in Augmented Reality-Guided L4 to L5 Transforaminal Interbody Fusion: A Methodologic
Okba Ghellab1, Andreas Seas2,3, Eric Shaker2
1Unit of Neurosurgery, Alouia Clinic, Birtouta, Algiers, Algeria.
International Journal of Spine Surgery
|November 3, 2025
Summary
Augmented reality (AR) enhances visualization during minimally invasive transfacet transforaminal lumbar interbody fusion (TF-TLIF), improving safety and potentially patient outcomes. This case report shows AR
Area of Science:
- Neurosurgery
- Medical Technology
- Spine Surgery
Background:
- Minimally invasive transfacet transforaminal lumbar interbody fusion (TF-TLIF) reduces tissue disruption but poses risks due to limited visualization.
- Neural injury, especially to nerve roots and thecal sac, is a concern in TF-TLIF.
Purpose of the Study:
- To illustrate the use of augmented reality (AR) for enhanced real-time visualization during TF-TLIF.
- To assess the feasibility and safety of AR-assisted TF-TLIF.
Main Methods:
- A case report detailing AR integration in TF-TLIF for a patient with L4-L5 spondylolisthesis.
- Preoperative 3D anatomical modeling from advanced imaging (MRI, CT, neurography).
- Intraoperative AR overlay via microscope, guided by 3D imaging and neurophysiological monitoring.
Main Results:
- AR provided continuous visualization of neural structures during critical surgical steps.
- The patient experienced no complications and had no new neurological deficits post-surgery.
- Discharge occurred on postoperative day 1.
Conclusions:
- AR-assisted TF-TLIF is feasible and may enhance safety in minimally invasive spine surgery.
- This technology shows promise as an adjunct for improved visualization.
- Further research is required to evaluate its impact on surgical efficiency and patient outcomes.
