Augmented Reality Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion: Safe and Effective Workflow with Intraoperative Video

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. Analyzing the learning curve revealed similar mean operative time, length of stay, estimated blood loss, and fluoroscopy time between the first half and latter half of cases. 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 AR headset mounted navigation represents safe and efficient enabling technology to enhance workflow in MIS TLIF. Given the limited field of view in MIS TLIF, AR improves visualization of anatomic landmarks in a 3D environment, highlighting the position of anatomic structures that are outside of the direct field of view.