Fabian Sommer, Ibrahim Hussain, Sertac Kirnaz, Jacob L. Goldberg, Rodrigo Navarro-Ramirez, Lynn B. McGrath Jr, Franziska A. Schmidt, Branden Medary, Pravesh Shankar Gadjradj, Roger Härtl
Neurospine 2025;22(2):619-619. Published online May 28, 2025
Objective Surgical resection of benign intradural extramedullary tumors (BIETs) is effective for appropriately selected patients. Minimally invasive surgical (MIS) techniques have been described for successful resection of BIET while minimizing soft tissue injury. Augmented reality (AR) is a promising new technology that can accurately allow for intraoperative localization from skin through the intradural compartment. We present a case series evaluating the timing, steps, and accuracy at which this technology is able to enhance BIET resection.
Methods A protocol for MIS and open AR-guided BIET resection was developed and applied to determine the feasibility. The tumor is marked on diagnostic magnetic resonance imaging (MRI) using AR software. Intraoperatively, the planning MRI is fused with the intraoperative computed tomography. The position and size of the tumor is projected into the surgical microscope and directly into the surgeon's field of view. Intraoperative orientation is performed exclusively via navigation and AR projection. Demographic and perioperative factors were collected.
Results Eight patients were enrolled. The average operative time for MIS cases was 128 ± 8 minutes and for open cases 206 ± 55 minutes. The estimated intraoperative blood loss was 97 ± 77 mL in MIS and 240 ± 206 mL in open procedures. AR tumor location and margins were considered sufficiently precise by the surgeon in every case. Neither correction of the approach trajectory nor ultrasound assistance to localize the tumor were necessary in any case. No intraoperative complications were observed.
Conclusion Current findings suggest that AR may be a feasible technique for tumor localization in the MIS and open resection of benign spinal extramedullary tumors.
Citations
Citations to this article as recorded by
Augmented Reality Assisted Spine Surgery: Applications and Future Directions Iyan Younus, Rafael Garcia de Oliveira, Kento Yamanouchi, Rajiv K. Sethi, Venu M. Nemani, Jean-Christophe Leveque, Philip K. Louie Operative Neurosurgery.2026;[Epub] CrossRef
Precise localization value of lumbar lamina and ligamentum flavum boundaries in minimally invasive tubular resection of intraspinal schwannomas Longfei Shu, Yan Liu, Feihu Dai, Chunmei Chen, Yuhai Wang, Wei Zhao Frontiers in Neurology.2026;[Epub] CrossRef
Digital 3D models in neurosurgical training, surgical planning, and intraoperative guidance: Narrative review of the literature Efecan Cekic, Gulsah Cetin, Ayse Gul Ozer, Baylar Baylarov, Egemen Gok, Ilkan Tatar, Sahin Hanalioglu World Neurosurgery: X.2026; 30: 100580. CrossRef
The Use of Augmented Reality as an Educational Tool in Minimally Invasive Transforaminal Lumbar Interbody Fusion Franziska A. Schmidt, Ibrahim Hussain, Blake Boadi, Fabian J. Sommer, Claudius Thomé, Roger Härtl Operative Neurosurgery.2025; 28(2): 183. CrossRef
Comprehensive Surgical Management of Thoracic Schwannomas: A Retrospective Multicenter Study on 98 Lesions Giuseppe Corazzelli, Sergio Corvino, Maria Marvulli, Valentina Cioffi, Alessandro D'Elia, Vincenzo Meglio, Roberto Tafuto, Ciro Mastantuoni, Maria Rosaria Scala, Francesco Ricciardi, Salvatore Di Colandrea, Settimio Leonetti, Pasqualino De Marinis, Sergio Neurosurgery.2025; 96(6): 1249. CrossRef
Systematic Review Comparing Open Versus Minimally Invasive Surgical Management of Intradural Extramedullary Tumours (IDEM) Asfand Baig Mirza, Ariadni Georgiannakis, Feras Fayez, Pak Yin Lam, Amisha Vastani, Christoforos Syrris, Dale Darbyshire, Kevin Tsang, Cheong Hung Lee, Amr Fahmy, Zaher Dannawi, Jose Pedro Lavrador, Irfan Malik, Gordan Grahovac, Jonathan Bull, Alexander M Journal of Clinical Medicine.2025; 14(5): 1671. CrossRef
Augmented Reality in Scoliosis Correction Surgery: Efficiency and Accuracy in Pedicle Screw Instrumentation Chia-Ning Chang, Chi-Ruei Li, Sian-Siang Liao, Chiung-Chyi Shen, Kai-Yuan Chen, Chung-Hsin Lee, Meng-Yin Yang Medicina.2025; 61(4): 576. CrossRef
A bibliometric analysis of augmented reality and mixed reality applied in minimally invasive surgery Zhenxin Cai, Yina Zhou, Zheyu Wen, Luhao Li, Yuexiong Yi Journal of Robotic Surgery.2025;[Epub] CrossRef
Multidisciplinary En-Bloc Resection of Sacral Chordoma: A Narrative Review and Illustrative Case Daniel Kiss-Bodolay, Frederic Ris, Adrien Lavalley, Aria Nouri, Carlo M. Oranges, Guillaume Meurette, Karl Schaller, Enrico Tessitore, Granit Molliqaj Journal of Clinical Medicine.2025; 14(13): 4480. CrossRef
Extended reality in the changing landscape of cranial neurosurgery: Role of image fusions and connectomics in precision and safety Gagandeep Singh, Annie Singh, Tejasvi Kainth, Sidharth Sunil Menon, Shubham Jain, Vadim Spektor, Prateek Prasanna, Sunil Manjila Journal of Clinical Neuroscience.2025; 142: 111652. CrossRef
Minimally invasive surgery outcomes for intradural extramedullary tumors: a systematic review and meta-analysis Ahmer Nasir Baig, Tabinda Tahir, Mohammad Hamza Bajwa, Faiza Urooj, Aimen Tameezuddin, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim World Neurosurgery: X.2025; 28: 100544. CrossRef
Unmasking benign intradural-extramedullary spinal tumors: a systematic review on treatment outcomes and radiological features Wojciech Czyżewski, Michał Szymoniuk, Jakub Litak, Jan Sobstyl, Klaudia Kus-Budzynska, Barbara Buchalska, Bipin Chaurasia, Tomasz Mandat, Kamil Torres, Grzegorz Staśkiewicz Annals of Medicine & Surgery.2025; 87(12): 8732. CrossRef
Augmented reality in spine surgery – past, present, and future Tej D. Azad, Anmol Warman, Jovanna A. Tracz, Liam P. Hughes, Brendan F. Judy, Timothy F. Witham The Spine Journal.2024; 24(1): 1. CrossRef
Augmented Reality Integration in Skull Base Neurosurgery: A Systematic Review Emir Begagić, Hakija Bečulić, Ragib Pugonja, Zlatan Memić, Simon Balogun, Amina Džidić-Krivić, Elma Milanović, Naida Salković, Adem Nuhović, Rasim Skomorac, Haso Sefo, Mirza Pojskić Medicina.2024; 60(2): 335. CrossRef
Image-Guided Navigation in Spine Surgery: From Historical Developments to Future Perspectives John Preston Wilson, Lane Fontenot, Caleb Stewart, Deepak Kumbhare, Bharat Guthikonda, Stanley Hoang Journal of Clinical Medicine.2024; 13(7): 2036. CrossRef
Single-Center Experience of Resection of 120 Cases of Intradural Spinal Tumors Mirza Pojskić, Miriam Bopp, Benjamin Saß, Christopher Nimsky World Neurosurgery.2024; 187: e233. CrossRef
The utility of intraoperative ultrasonography for spinal cord surgery Hangeul Park, Jun-Hoe Kim, Chang-Hyun Lee, Sum Kim, Young-Rak Kim, Kyung-Tae Kim, Ji-hoon Kim, John M. Rhee, Woo-Young Jo, Hyongmin Oh, Hee-Pyoung Park, Chi Heon Kim, Barry Kweh PLOS ONE.2024; 19(7): e0305694. CrossRef
More than meets the eye: Augmented reality in surgical oncology Kavita Prasad, Carly Fassler, Alexis Miller, Marina Aweeda, Sumit Pruthi, Joseph C. Fusco, Bruce Daniel, Michael Miga, Jie Ying Wu, Michael C. Topf Journal of Surgical Oncology.2024; 130(3): 405. CrossRef
Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor Xiang Yin, Keyu Luo, Yufei Jin, Yaoyao Liu, Yinbo Wang, Mingyong Liu, Peng Liu Orthopaedic Surgery.2023; 15(3): 819. CrossRef
Augmented Reality in Neurosurgery: A New Paradigm for Training Grace Hey, Michael Guyot, Ashley Carter, Brandon Lucke-Wold Medicina.2023; 59(10): 1721. CrossRef
The Future of Neuroendoscopy: Looking Ahead Through a Lens Umberto Tosi, Mark M. Souweidane World Neurosurgery.2023; 178: 311. CrossRef
Fabian Sommer, Ibrahim Hussain, Sertac Kirnaz, Jacob L. Goldberg, Rodrigo Navarro-Ramirez, Lynn B. McGrath Jr, Franziska A. Schmidt, Branden Medary, Pravesh Shankar Gadjradj, Roger Härtl
Neurospine 2022;19(3):574-585. Published online September 30, 2022
Objective Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a highly reproducible procedure for the fusion of spinal segments. We recently introduced the concept of “total navigation” to improve workflow and eliminate fluoroscopy. Imageguided surgery incorporating augmented reality (AR) may further facilitate workflow. In this study, we developed and evaluated a protocol to integrate AR into the workflow of MISTLIF.
Methods A case series of 10 patients was the basis for the evaluation of a protocol to facilitate tubular MIS-TLIF by the application of AR. Surgical TLIF landmarks were marked on a preoperative computed tomography (CT)-scan using dedicated software. This marked CT scan was fused intraoperatively with the low-dose navigation CT scan using elastic image fusion, and the markers were transferred to the intraoperative scan. Our experience with this workflow and the surgical outcomes were collected.
Results Our AR protocol was safely implemented in all cases. The TLIF landmarks could be preoperatively planned and transferred to the intraoperative imaging. Of the 10 cases, 1 case had additionally a synovial cyst resection and in 2 cases an additional bony decompression was performed due to central stenosis. The average procedure time was 160.6 ± 31.9 minutes. The AR implementation added 1.72 ± 0.37 minutes to the overall procedure time. No complications occurred.
Conclusion Our findings support the idea that total navigation with AR may further facilitate the workflow, especially in cases with more complex anatomy and for teaching and training purposes. More work is needed to simplify the software and make AR integration more user-friendly.
Citations
Citations to this article as recorded by
Augmented Reality Assisted Spine Surgery: Applications and Future Directions Iyan Younus, Rafael Garcia de Oliveira, Kento Yamanouchi, Rajiv K. Sethi, Venu M. Nemani, Jean-Christophe Leveque, Philip K. Louie Operative Neurosurgery.2026;[Epub] CrossRef
The Emerging Reality: A Narrative Review of Virtual, Augmented, and Mixed Reality in Modern Spine Surgery Satish Rudrappa, Swaroop Gopal, Mohammad Sohrab, Ramachandran Govindasamy, Megha M Rao Indian Spine Journal.2026; 9(1): 27. CrossRef
Complications in Minimally Invasive Spine Surgery (2013–2024): Lumbar Spine—Tubular Minimally Invasive Techniques Chibuikem A. Ikwuegbuenyi, Sean Inzerillo, Eesha Gurav, Noah Willett, Mousa Hamad, Alan Hernández-Hernández, Ibrahim Hussain, Galal Elsayed, Osama Kashlan, Roger Härtl Spine.2026; 51(4): E78. CrossRef
The Role of Enabling Technologies in Spine Surgery in India: Expert Consensus Based on Narrative Review Harvinder Singh Chhabra, Bharat R. Dave, Amit Jhala, Ankur Nanda, Gururaj Sangondimath, Pankaj Kandwal, Puneet Girdhar, Shailesh Hadgaonkar, Umesh Srikantha, Vidyadhara Srinivasa, Sudhir Dubey Indian Spine Journal.2026; 9(1): 3. CrossRef
Augmented reality assisted minimally invasive transforaminal lumbar interbody fusion: feasible and effective workflow with intraoperative video Iyan Younus, Rafael Garcia de Oliveira, Patricia Lipson, Aiyush Bansal, Philip Louie European Spine Journal.2026;[Epub] CrossRef
Artificial Intelligence and Robotics in General Surgery: Opportunities and Challenges Sepehr Seifi, Hadi Sahrai, Negin Safari Dehnavi, Fatemeh Amiri, Seyed Mohammad Amin Dashti, Ali Noruzi, Niloofar Taheri, Reza Mosaddeghi-Heris, Ali Seifi Cureus.2026;[Epub] CrossRef
The Use of Augmented Reality as an Educational Tool in Minimally Invasive Transforaminal Lumbar Interbody Fusion Franziska A. Schmidt, Ibrahim Hussain, Blake Boadi, Fabian J. Sommer, Claudius Thomé, Roger Härtl Operative Neurosurgery.2025; 28(2): 183. CrossRef
Posterior and Transforaminal Lumbar Interbody Fusion Arpan A. Patel, Shaarada Srivatsa, Mark A. Davison, Michael P. Steinmetz Neurosurgery Clinics of North America.2025; 36(1): 11. CrossRef
Augmented Reality in Spine Surgery Bayard R. Wilson, Timothy Y. Wang, John O'Toole Neurosurgery.2025; 96(3S): S103. CrossRef
Evolution of the Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion: Where Are We Now? Abraham Dada, Satvir Saggi, Vardhaan S. Ambati, Arati Patel, Praveen V. Mummaneni Neurosurgery.2025; 96(3S): S33. CrossRef
Augmented Reality in Scoliosis Correction Surgery: Efficiency and Accuracy in Pedicle Screw Instrumentation Chia-Ning Chang, Chi-Ruei Li, Sian-Siang Liao, Chiung-Chyi Shen, Kai-Yuan Chen, Chung-Hsin Lee, Meng-Yin Yang Medicina.2025; 61(4): 576. CrossRef
The Evolution of Spatial Computing in Spine Surgery: Tracing the Historical Arc to Present Day Implementation Galal A. Elsayed, Gabrielle Dykhouse, Chibuikem A. Ikwuegbuenyi, Noah Willett, Ibrahim Hussain, Mousa Hamad, Osama Nezar Kashlan, Roger Härtl World Neurosurgery.2025; 204: 124514. CrossRef
Augmented reality in spine surgery – past, present, and future Tej D. Azad, Anmol Warman, Jovanna A. Tracz, Liam P. Hughes, Brendan F. Judy, Timothy F. Witham The Spine Journal.2024; 24(1): 1. CrossRef
Innovations in Spine Surgery: A Narrative Review of Current Integrative Technologies George Bcharah, Nithin Gupta, Nicholas Panico, Spencer Winspear, Austin Bagley, Morgan Turnow, Randy D'Amico, Alvan-Emeka K. Ukachukwu World Neurosurgery.2024; 184: 127. CrossRef
Augmented Reality Integration in Skull Base Neurosurgery: A Systematic Review Emir Begagić, Hakija Bečulić, Ragib Pugonja, Zlatan Memić, Simon Balogun, Amina Džidić-Krivić, Elma Milanović, Naida Salković, Adem Nuhović, Rasim Skomorac, Haso Sefo, Mirza Pojskić Medicina.2024; 60(2): 335. CrossRef
Using Augmented Reality Technology to Optimize Transfacet Lumbar Interbody Fusion: A Case Report Anas Bardeesi, Troy Q. Tabarestani, Stephen M. Bergin, Chuan-Ching Huang, Christopher I. Shaffrey, Walter F. Wiggins, Muhammad M. Abd-El-Barr Journal of Clinical Medicine.2024; 13(5): 1513. CrossRef
Image-Guided Navigation in Spine Surgery: From Historical Developments to Future Perspectives John Preston Wilson, Lane Fontenot, Caleb Stewart, Deepak Kumbhare, Bharat Guthikonda, Stanley Hoang Journal of Clinical Medicine.2024; 13(7): 2036. CrossRef
Improving Patient Education Using Augmented Reality for Spine Fractures: Feasibility Study and Review of Literature David J. Mazur-Hart, Jamila A. Godil, Brandi W. Pang, Adeline Fecker, Dominic A. Siler, Samantha Yau, James T. Obayashi, Jesse Courtier, Won Hyung A. Ryu Journal of Medical Extended Reality.2024; 1(1): 84. CrossRef
Augmenting Reality in Spinal Surgery: A Narrative Review of Augmented Reality Applications in Pedicle Screw Instrumentation Sheng-Xian Xiao, Wen-Tien Wu, Tzai-Chiu Yu, Ing-Ho Chen, Kuang-Ting Yeh Medicina.2024; 60(9): 1485. CrossRef
Complications in Minimally Invasive Spine Surgery in the Last 10 Years: A Narrative Review Blake I. Boadi, Chibuikem Anthony Ikwuegbuenyi, Sean Inzerillo, Gabrielle Dykhouse, Rachel Bratescu, Mazin Omer, Osama N. Kashlan, Galal Elsayed, Roger Härtl Neurospine.2024; 21(3): 770. CrossRef
Augmented Reality Support for Anterior Decompression and Fusion Using Floating Method for Cervical Ossification of the Posterior Longitudinal Ligament Hiroaki Onuma, Kenichiro Sakai, Yoshiyasu Arai, Ichiro Torigoe, Masaki Tomori, Kyohei Sakaki, Takashi Hirai, Satoru Egawa, Yutaka Kobayashi, Atsushi Okawa, Toshitaka Yoshii Journal of Clinical Medicine.2023; 12(8): 2898. CrossRef
Augmented Reality in Minimally Invasive Spinal Surgery: A Narrative Review of Available Technology Noah Pierzchajlo, Taylor C. Stevenson, Huey Huynh, Jimmy Nguyen, Samuel Boatright, Priya Arya, Sachiv Chakravarti, Yusuf Mehrki, Nolan J. Brown, Julian Gendreau, Seung Jin Lee, Selby G. Chen World Neurosurgery.2023; 176: 35. CrossRef
The Future of Neuroendoscopy: Looking Ahead Through a Lens Umberto Tosi, Mark M. Souweidane World Neurosurgery.2023; 178: 311. CrossRef
First
Prev
