Augmented Reality Navigation for Extreme Lateral Interbody Fusion with Posterior Instrumentation: Feasibility, Outcomes, and Surgical Technique

TL;DR

This paper introduces augmented reality navigation for a minimally invasive spine surgery, showing it reduces radiation exposure and improves accuracy.

Contribution

The first clinical application of augmented reality navigation in extreme lateral interbody fusion surgery is described.

Findings

AR navigation reduced radiation exposure to 21.73 mGy, significantly lower than fluoroscopy-guided procedures.

All patients achieved accurate instrumentation and reported pain reduction, with four out of five experiencing complete symptom resolution.

Abstract

Background: Extreme lateral interbody fusion (XLIF) is a minimally invasive spine procedure that traditionally relies on fluoroscopy and neuromonitoring for safe disc space access and instrumentation. Augmented reality (AR) navigation offers real-time anatomical visualization and may reduce fluoroscopy use. This is the first description of applying augmented reality to lateral spine surgery. Methods: We conducted a case series of five patients who underwent AR-guided LLIF between May 2024 and July 2025. Surgery was performed in either lateral decubitus or prone transpsoas (PTP) orientation. AR navigation was performed using the Augmedics xvision Spine System, with intraoperative CT–based registration and optical tool tracking. Clinical and operative data, including operative time, estimated blood loss (EBL), length of stay (LOS), radiation exposure, instrumentation accuracy, and postoperative outcomes, were collected and analyzed. Results: Five patients (4 female, 1 male; age > 65; BMI range 20.7–37.2) underwent AR-guided XLIF across 8 levels (L2–L5). The mean operative time was 5 h 1 min (range: 2 h 8 min–6 h 45 min), and mean EBL was 94 mL. Mean LOS was 5.85 days (range: 2–10). Mean radiation exposure was 21.73 mGy, significantly lower than published averages for fluoroscopy-guided XLIF (108.6 mGy). At follow-up, all patients reported pain reduction, with 4/5 achieving complete symptom resolution. Instrumentation accuracy was confirmed radiographically in all cases. Conclusions: This clinical series demonstrates the first clinical application of AR to lateral lumbar interbody fusion. AR navigation was feasible, safe, and effective, providing accurate disc space access and instrumentation with markedly reduced radiation exposure. These findings support AR as a promising adjunct to improve safety, efficiency, and workflow in lateral spine surgery.

Figures