Augmented Reality Enhances Lateral Interbody Fusion by Improving Efficiency and Reducing Radiation

Introduction: Augmented reality (AR) utilizes optical images projected into the user’s field of view to create a digital overlay. Lumbar lateral interbody fusion (XLIF) cases can be challenging secondary to positioning of the patients. Extensive fluoroscopy is necessary to find a safe corridor into the disc space while avoiding the lumbar plexus. Here we demonstrate the addition of AR to the life cycle of XLIF surgery.

Methods: The patient was positioned in left lateral decubitus for extreme lateral or prone for the transpsoas approach. Intra-operative CT was performed, and the data loaded into the Xvision console. The surgeon was fitted with the Xvision head-mounted display. After standard fashion exposure, 3D AR visualization navigated a guidewire with an attached navigation array into the target disc space without the use of fluoroscopy. The area around the guidewire was stimulated and once deemed safe, retractors were placed and the XLIF continued in standard fashion.

Results: Five patients underwent AR-guided XLIF at eight levels, including two revision surgeries for adjacent segment disease and three primary cases. Levels treated were L2/3 (2), L3/4 (5), and L4/5 (1). AR successfully navigated the guidewire into the target disc space without fluoroscopy, also aiding in discectomy planning and final interbody placement. No major complications or lumbar plexopathies occurred. Fluoroscopy time was significantly reduced (p < 0.01) compared to traditional XLIF. Post-op X-rays confirmed accurate instrumentation placement. In three single-position cases, percutaneous MIS pedicle screws were placed using AR, eliminating the need for an additional OR spin.

Conclusion : AR can successfully be utilized for XLIF. The integration of the technology allows for not only placement of pedicle screws, but also precise and safe navigation into the lateral disc space. This reduces the traditional reliance on fluoroscopy when accessing the lateral disc space. Additionally, AR negates the need for radiation use for access to the disc space and placement of pedicle screws.