Augmented reality-enabled image-guided surgical navigation in minimally invasive spine surgery: application beyond...

Augmented reality-enabled image-guided surgical navigation (ARE-IGSN) has demonstrated high accuracy for pedicle screw placement in spine surgery, but its application to interbody phases of minimally invasive fusion remains largely unexplored. Interbody work typically requires repeated fluoroscopic confirmation, increasing radiation exposure and forcing frequent gaze shifts away from the operative field. This study aims to evaluate the feasibility and accuracy of ARE-IGSN for key interbody steps in prone lateral transpsoas interbody fusion, including skin marking, corridor selection, disc preparation, evaluation of endplate integrity, and cage trajectory and depth control. A fresh frozen cadaver specimen was positioned in a prone lateral configuration with pelvic reference frame registration to a preprocedural computed tomography (CT) scan. An ARE-IGSN platform was used to provide in-field navigation overlays throughout the procedure. The workflow included navigated skin marking, docking, disc preparation using calibrated instruments, and interbody cage placement. Primary endpoints were technical feasibility, implant placement accuracy assessed by comparison of ARE-IGSN data with postprocedural CT imaging, and endplate integrity. Secondary endpoints included fluoroscopy utilization and qualitative ergonomic assessment. ARE-IGSN guidance was used throughout the procedure for skin marking, corridor selection, docking, disc preparation, endplate evaluation, trialing, and cage placement. The procedure was completed without the use of procedural fluoroscopy following system registration. Postprocedural CT demonstrated close agreement between the implant position displayed by the ARE-IGSN system and the final implant position. Retrospective comparison of measurements obtained from the saved ARE-IGSN data and postprocedural CT imaging demonstrated less than 1 mm difference across all assessed parameters, with no evidence of endplate violation. Visualization of navigational information was provided directly through the headset display throughout the procedure. This cadaveric study demonstrates the technical feasibility of applying ARE-IGSN guidance to multiple phases of prone lateral transpsoas interbody fusion beyond pedicle screw placement. Retrospective comparison of saved ARE-IGSN navigational data with postprocedural CT imaging demonstrated close agreement between the implant position displayed by the system and the final implant position. These findings support further prospective clinical investigation of implant placement accuracy, workflow integration, radiation utilization, and ergonomic outcomes.