Use of Augmented Reality Image Guidance for Performing Minimally Invasive TLIF in the Outpatient Surgical Center

Introduction: Complex spine surgery cases including MI-TLIF are increasingly being performed in the ambulatory surgical center (ASC). Augmented reality image guidance head-set allow the surgeon to view the 3D anatomy of the spine without removing tissue for placement of percutaneous pedicle screws. Augmented image guidance has many advantages compare to robotic systems including reduce surgical image guidance cost, eliminate or limit radiation exposure to patients and operative personnel, and ease of surgeon placement of percutaneous pedicle screws.

Methods: Augmented reality image guidance navigation has recently been introduced into the outpatient surgical center environment. An initial series of MI-TLIF using augmented reality image guidance for placement of percutaneous pedicle screws was conducted at our ASC.

Results: Surgeons navigated placement of all percutaneous pedicle screws. Average set-up time was 15 minutes including flouroscopic spin to generate computer tomography (CT) images for navigation. Percutaneous pedicle screws for one level MI-TLIF averaged less than 20 minutes. Accuracy of screw placement was excellent and confirmed using intra-operative electrophysiologic monitoring and post-instrumentation placement flouroscopic CT spin confirmation. A cost analysis revealed significant cost saving compared to robotic image guidance systems.

Conclusion : Use of aumented reality spine surgery for percutaneous pedicle screw placement has significant benefits in the ambulatory surgery center including reduction of x-ray exposure to patient and operating room personnel, accuracy of screw placement, and reduce ASC cost burden.