Overlay of Nerve Roots to Aid in Augmented Reality-Guided L4 to L5 Transforaminal Interbody Fusion: A Methodologic Pilot.

BACKGROUND: Minimally invasive transfacet transforaminal lumbar interbody fusion (TF-TLIF) offers advantages over open approaches, including reduced tissue disruption and faster recovery. However, limited visualization increases the risk of neural injury, particularly to the exiting nerve roots and thecal sac. INNOVATION: This case report illustrates the integration of augmented reality (AR) to enhance real-time visualization during TF-TLIF. A 53-year-old man with symptomatic L4 to L5 spondylolisthesis underwent AR-assisted TF-TLIF. Preoperative imaging included magnetic resonance imaging, computed tomography, and advanced neurography sequences (Multi-Echo iN Steady-state Acquisition, Short Tau Inversion Recovery, and Dixon T1), which were used to generate a 3D model of critical anatomy. A safe transfacet trajectory was planned preoperatively and overlaid onto the surgical field through the operative microscope, using intraoperative 3D imaging for registration. Intraoperative neurophysiological monitoring complemented visual guidance. CLINICAL RELEVANCE: AR enabled continuous visualization of neural structures during drilling, discectomy, and cage placement. The patient had no complications and was discharged on postoperative day 1 without new neurological deficits. While limited to a single case, this report demonstrates the feasibility of AR-assisted TF-TLIF. This technology may serve as a promising adjunct in minimally invasive spine surgery. Further studies are needed to assess the impact on efficiency and outcomes.

Duke Scholars

Author Muhammad Abd-El-Barr Neurosurgery