European Spine Journal - 2026-05-04 - Journal Article
Augmented reality assisted minimally invasive transforaminal lumbar interbody fusion: feasible and effective workflow with intraoperative video.
Younus I, Garcia de Oliveira R, Lipson P, Bansal A, Louie P
Topics
Key Takeaway
AR-assisted MIS-TLIF in 22 consecutive patients achieved mean operative time of 129 minutes, fluoroscopy time of 41 seconds, EBL of 51 mL, and LOS of 1.9 days with a 9% reoperation rate at mean 163-day follow-up.
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Summary
This study describes a workflow for headset-mounted AR navigation integrated into single-level MIS-TLIF for degenerative spondylolisthesis, reporting perioperative outcomes in 22 consecutive cases from a larger 138-patient AR fusion cohort. Mean fluoroscopy time was 41 seconds and EBL was 51 mL, consistent with published MIS-TLIF benchmarks. Two patients (9%) required reoperation at a mean of 5 weeks, and no persistent neurologic deficits were reported at short-term follow-up.
Key Limitation
The 9% reoperation rate at only 5 weeks in a 22-patient cohort is clinically concerning and cannot be contextualized without a comparator group or longer follow-up.
Original Abstract
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/m 2 , 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.