Related Experiment Video
Updated: May 5, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Augmented reality assisted minimally invasive transforaminal lumbar interbody fusion: feasible and effective workflow
Iyan Younus1,2, Rafael Garcia de Oliveira3, Patricia Lipson3
1Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, USA. iyan.younus@gmail.com.
Purpose:
This article and accompanying video provide a comprehensive workflow for incorporating headset-mounted augmented reality (AR) navigation for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
Methods:
Consecutive patients undergoing a single level MIS-TLIF with AR navigation for degenerative spondylolisthesis were analyzed between January 2023-2025. Demographic, intraoperative, and postoperative outcomes were collected. The AR workflow features a wireless headset with projection of intraoperative navigation in the surgical field. MIS pedicle screw placement, facetectomy, disc preparation, and contralateral arthrodesis are carried out percutaneously though single line of sight using navigated instruments.
Result:
A total of 138 consecutive patients underwent AR-assisted spinal fusion at our institution and 22 cases of single-level MIS TLIF met inclusion criteria. Mean age was 62.3 ± 15 years, 59% were females, mean BMI was 29.4±5.7 kg/m2, and mean CCI score was 2.1±1.5. The mean operative time from incision to closure for the entire cohort was 129±28 min, mean fluoroscopy time was 41±12 s, EBL was 51±33 ml, and the mean length of stay was 1.9±1.8 days. Two (9%) patients required reoperation at a mean 5 weeks. The AR protocol was safely implemented in all cases with improvement in back and leg pain and no persistent neurologic deficits at mean 163 day follow up.
Conclusion:
Headset-mounted AR navigation is a feasible and reproducible tool to provide visualization for MIS TLIF that can be successfully integrated into surgical workflow. In this initial case series, its use was associated with an acceptable early safety profile and consistent perioperative outcomes. However, given the limitations of this study, including its retrospective design and lack of a comparator cohort, further prospective and comparative studies are necessary to evaluate its impact on surgical efficiency, accuracy, and clinical outcomes.
