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Original Article

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Optimization of Paravertebral Foramen Screw Placement: A Stepwise Approach Considering O-arm Navigation Errors: Technical Note and Case Series
Neurospine. 2025;22(2):514-522.   Published online June 30, 2025
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Optimization of Paravertebral Foramen Screw Placement: A Stepwise Approach Considering O-arm Navigation Errors: Technical Note and Case Series
Neurospine. 2025;22(2):514-522.   Published online June 30, 2025
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Objective
Paravertebral foramen screws (PVFSs) have been developed for better pullout strength than lateral mass screws do and lower the risk of vertebral artery and nerve injury than do pedicle screws. While the original method involves insertion using lateral fluoroscopy, its reliability may be limited. This report is the first to assess the accuracy of PVFS insertion under navigation. Given the inherent inaccuracies associated with navigation systems, the authors propose and evaluate a novel stepwise method of inserting PVFSs, called stepwise PVFS with a focus on achieving the correct screw tip location for good cortical bone purchase.
Methods
The authors conducted a retrospective analysis of 12 patients (78 screws) who underwent cervical spine fixation with stepwise PVFS under O-arm navigation between October 2022 and February 2024. The accuracy of screw placement was evaluated using postoperative computed tomography (CT) scans.
Results
A total of 78 PVFSs were inserted in 5 men and 7 women, with an average age of 75 years (range, 52–85 years). The mean follow-up period was 471 days (range, 47–834 days). There were no adverse events related to screw insertion. Postoperative CT scans revealed that 70 screws (90%) were placed in the ideal position. Among the 8 screws that did not achieve the ideal position, 4 had lateral deviation (located in a lateral mass), whereas the other 4 were too short. There were no cases of screw loosening at the final follow-up.
Conclusion
The present study demonstrates that the stepwise PVFS method under navigation guidance achieves higher accuracy in PVFS placement compared with conventional fluoroscopy-guided PVFS, as reported in previous studies.
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Review Article

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The Utilization of Navigation and Emerging Technologies With Endoscopic Spine Surgery: A Narrative Review
Neurospine. 2025;22(1):105-117.   Published online March 31, 2025
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The Utilization of Navigation and Emerging Technologies With Endoscopic Spine Surgery: A Narrative Review
Neurospine. 2025;22(1):105-117.   Published online March 31, 2025
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Endoscopic spine surgery (ESS) is growing in popularity worldwide. An expanding body of literature demonstrates rapid functional recovery with reduced morbidity compared to open techniques. Both full endoscopic spine surgery, or uniportal endoscopy, and unilateral biportal endoscopy (UBE) can be employed in conjunction with various navigation and enabling technologies for assistance with localization of anatomic orientation and assessment of the intraoperative target spinal pathology. This review article describes various navigation technologies in ESS, including 2-dimensional (2D) fluoroscopic imaging, 2D fluoroscopic navigation, 3-dimensional C-arm navigation, augmented reality, and spinal robotics. Employment of enabling navigation and emerging technology with the registration of patient-specific anatomy enables clear delineation of anatomic landmarks and facilitation of a successful procedure. Additionally, avoidance of common pitfalls during use of navigation systems in ESS is discussed in this review.

Citations

Citations to this article as recorded by  Crossref logo
  • Lumbar spinal stenosis: current concept of management
    Ji-Won Kwon, Kyung-Soo Suk, Seong-Hwan Moon, Si-Young Park, Namhoo Kim, Sub-Ri Park, Jae-Won Shin, Hak-Sun Kim, Byung Ho Lee
    Asian Spine Journal.2026; 20(1): 143.     CrossRef
  • Delta large-channel endoscopy versus unilateral biportal endoscopy for cervicothoracic junction disc herniation: a prospective randomized controlled trial
    Huaibin Wang, Hui Li, Rushuo Wei, Hao Yan, Ruzhan Yao, Weiqiang Liu, Ling Li
    Journal of Orthopaedic Surgery and Research.2026;[Epub]     CrossRef
  • Intraoperative Dual-Cantilever Probe for Rapid Measurement of Cancellous Bone Compressive Strength Within the Vertebral Body
    Owen Kresse, Evelyn Khong, Gerhardus O. Loohuis, R. Elayne Shelby, Maxwell Boakye, Michael J. Voor, Stuart J. Williams
    Journal of Medical Devices.2026;[Epub]     CrossRef
  • Assisted full-endoscopic spine surgery for lumbar spinal stenosis: Technical note and learning curve
    Koichiro Ono, Daisuke Fukuhara, Yuka Yamami, Yushi Yamaguchi, Kazuma Miura, Yuki Kasuga, Kaichi Sato, Satoshi Takamoto, Naoya Takabayshi, Hiroshi Kawaguchi, Makoto Hirao
    Brain and Spine.2026; 6: 105935.     CrossRef
  • Thoracic Full-Endoscopic Decompression for Ossification of Ligamentum Flavum (OLF) Causing Myelopathy
    Rohit A. Thaker, Smit Kagathara, Pratik Shah
    Indian Spine Journal.2026; 9(1): 112.     CrossRef
  • Real-time Three-dimensional Navigation in Spine Surgery: Is It the Game Changer?
    Shailesh Hadgaonkar, Siddharth Aiyer, Abhinav Bhute, Parag Sancheti
    Indian Spine Journal.2026; 9(1): 37.     CrossRef
  • A retrospective Chinese study on optical–electromagnetic navigation-guided biportal endoscopic unilateral laminotomy for bilateral decompression in lumbar spinal stenosis: improving precision and efficiency
    Xingchen Yao, Junpeng Liu, Li Guan, Jincai Yang, Aixing Pan, Yong Hai
    Asian Spine Journal.2026;[Epub]     CrossRef
  • Robotic-Assisted Uniportal Full-Endoscopic Transforaminal Lumbar Interbody Fusion: A Technical Note on a Hybrid Form of Minimally Invasive Surgery
    Ting Yao Ang, A. Aravin Kumar, Chin Hong Ngai, John J.Y. Zhang, Jacob Y.L. Oh, Ji Min Ling, Thomas C.H. Tan
    Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(1): 105.     CrossRef
  • O‐Arm Navigation Enhances Facet Preservation Without Compromising Clinical Outcomes in UBE Decompression for Radiographically Stable Adult Degenerative Scoliosis: A Single‐Center Comparative Study
    Yi Liu, Yiwei Xie, Zhibao Chen, Ruijun Xu, Haojie Chen, Xiaojian Ye, Jiangming Yu
    Orthopaedic Surgery.2026; 18(6): 1203.     CrossRef
  • EndoUFM: Utilizing foundation models for monocular depth estimation of endoscopic images
    Xinning Yao, Bo Liu, Bojian Li, Jingjing Wang, Jinghua Yue, Fugen Zhou
    Neural Networks.2026; 203: 109141.     CrossRef
  • Transforaminal Endoscopic Lumbar Discectomy Versus Interlaminar Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review of Clinical Outcomes, Quality of Life, and Surgical Selection Strategies
    MOHAMMAD RIYAD ABDULWAHID AL-HASNAWI, Hadi Ali Hadi Dala Ali, Rasool Riyadh Abdulwahid Al Hasnawi, Ameer Neamah Saadoon Al-Mhemis, Hinal Alkeshkumar Patel, Oumaima Souilhi, Mustafa Faris Kadhim Kadhim, Mohammed ali modher abduljaleel
    Orthopedic Reviews.2026;[Epub]     CrossRef
  • Establishing navigated UBE in Europe – technical note
    Nicole Lange, Carolin Albrecht, Raimunde Liang, Luisa Mona Kraus, Ghaith Altawalbeh, Shadi Abulhala, Ann-Kathrin Joerger, Bernhard Meyer
    Brain and Spine.2026; 6: 106107.     CrossRef
  • Endoscopic‐Assisted Posterior Atlantoaxial Fusion: Technical Innovation and Clinical Experience
    Jichong Zhu, Chengqian Huang, Jiang Xue, Jiarui Chen, Yufan Xu, Dequan Liu, Xinli Zhan, Chong Liu
    Orthopaedic Surgery.2026;[Epub]     CrossRef
  • Research Progress on Percutaneous Endoscopic Treatment for Radicular Cervical Spondylosis
    怀忠 周
    Advances in Clinical Medicine.2026; 16(06): 2540.     CrossRef
  • Comparative Clinical and Radiological Outcomes of Arthroscopic‐Assisted Uniportal Spinal Surgery Versus Unilateral Biportal Endoscopy for Unilateral Laminotomy With Bilateral Decompression in Lumbar Spinal Stenosis: A 2‐Year Follow‐Up Study
    Abdul Waheed Bahir, Wang Daxing, Liu Bailian, Gan Xuewen, Xiong Ying, Xiao Jiayu, Gu Shao
    Orthopaedic Surgery.2026;[Epub]     CrossRef
  • Full-endoscopic extraforaminal lumbar discectomy: Use of 3-D image-guidance can mitigate risks and overcome steep learning curve
    Anwesha Dubey, Abhijith R. Bathini, Katherine Anastasi, Joshua Bakhsheshian
    Journal of Clinical Neuroscience.2025; 139: 111455.     CrossRef
  • Navigated Uniportal Endoscopic Decompression for Thoracic Myelopathy Secondary to Ossified Yellow Ligament: A Report of Two Cases
    Bing Wui Ng, Ozlan Izma Muhamed Kamil
    Cureus.2025;[Epub]     CrossRef
  • 11,381 View
  • 265 Download
  • 16 Web of Science
  • 17 Crossref

Original Article

Minimally Invasive Spine Surgery

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Integrated Optical and Magnetic Navigation for Simplified Percutaneous Transforaminal Endoscopic Lumbar Discectomy: A Novel Approach
Neurospine. 2025;22(1):297-307.   Published online January 22, 2025
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Integrated Optical and Magnetic Navigation for Simplified Percutaneous Transforaminal Endoscopic Lumbar Discectomy: A Novel Approach
Neurospine. 2025;22(1):297-307.   Published online January 22, 2025
Close
Objective
This study aims to evaluate the clinical benefits of the integrated optical and magnetic surgical navigation system in assisting transforaminal endoscopic lumbar discectomy (TELD) for the treatment of lumbar disc herniation (LDH).
Methods
A retrospective analysis was conducted on patients who underwent TELD for LDH at Beijing Chaoyang Hospital, Capital Medical University from November 2022 to December 2023. Patients treated with the integrated optical and magnetic surgical navigation system were defined as the navigation-guided TELD (Ng-TELD) group (30 cases), while those treated with the conventional x-ray fluoroscopy method were defined as the control group (31 cases). Record and compare baseline characteristics, surgical parameters, efficacy indicators, and adverse events between the 2 patient groups.
Results
The average follow-up duration for the 61 patients was 11.8 months. Postoperatively, both groups exhibited significant relief from back and leg pain, which continued to improve over time. At the final follow-up, patients’ lumbar function and quality of life had significantly improved compared to preoperative levels (p < 0.05). The Ng-TELD group had significantly shorter total operation time (58.43 ± 12.37 minutes vs. 83.23 ± 25.90 minutes), catheter placement time (5.83 ± 1.09 minutes vs. 15.94 ± 3.00 minutes), decompression time (47.17 ± 11.98 minutes vs. 67.29 ± 24.23 minutes), and fewer intraoperative fluoroscopies (3.20 ± 1.45 vs. 16.58 ± 4.25) compared to the control group (p < 0.05). There were no significant differences between the groups in terms of efficacy evaluation indicators and hospital stay. At the final follow-up, the excellent and good rate of surgical outcomes assessed by the MacNab criteria was 98.4%, and the overall adverse event rate was 8.2%, with no statistically significant differences between the groups (p > 0.05).
Conclusion
This study demonstrates that the integrated optical and magnetic surgical navigation system can reduce the complexity of TELD, shorten operation time, and minimize radiation exposure for the surgeon, highlighting its promising clinical potential.

Citations

Citations to this article as recorded by  Crossref logo
  • A retrospective Chinese study on optical–electromagnetic navigation-guided biportal endoscopic unilateral laminotomy for bilateral decompression in lumbar spinal stenosis: improving precision and efficiency
    Xingchen Yao, Junpeng Liu, Li Guan, Jincai Yang, Aixing Pan, Yong Hai
    Asian Spine Journal.2026;[Epub]     CrossRef
  • Full-Endoscopic Lumbar Discectomy: A Review of the Surgical Techniques, Indications and Anatomical Considerations
    Stylianos Kapetanakis, Mikail Chatzivasiliadis, Nikolaos Gkantsinikoudis, Konstantinos Pazarlis
    Journal of Clinical Medicine.2025; 14(24): 8961.     CrossRef
  • 6,073 View
  • 151 Download
  • 3 Web of Science
  • 2 Crossref

Video Articles

Video Articles: Special Issue With JMISST

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O-Arm Navigation-Guided Unilateral Biportal Endoscopic Decompression of Far-Out Syndrome
Neurospine. 2024;21(4):1149-1153.   Published online December 31, 2024
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O-Arm Navigation-Guided Unilateral Biportal Endoscopic Decompression of Far-Out Syndrome
Neurospine. 2024;21(4):1149-1153.   Published online December 31, 2024
Close
The main aim of this video article is to demonstrate the combined use of O-arm navigation and unilateral biportal endoscopy (UBE) to manage far-out syndrome (FOS). In FOS there is entrapment and compression of the fifth lumbar nerve beyond the foramen and between L5 transverse process and the sacral ala at the lumbosacral junction. Conventional microscopic decompression using a paraspinal approach had been the gold standard for its management. However, the surgery is technically challenging due to the deep location of the pathology and intricate anatomy of extraforaminal space. There have been some published reports of unsatisfactory outcomes with microscopic decompression for FOS. We decided to integrate navigation with UBE to increase precision for the management of FOS. A 70-year-old female presented to us with chief complaint of left lower limb radiculopathy since 1 year. She also complained of numbness and paresthesias in her left leg and foot. She was unable to walk for more than 10 minutes due to pain. Her magnetic resonance imaging scan revealed compression of left L5 nerve root in the extraforaminal region. UBE decompression via paraspinal approach was performed for her under O-arm navigation. She experienced immediate relief of her symptoms in the postoperative period. O-arm-navigation-guided UBE is an effective and safer alternative to microsurgical decompression for the management of FOS. This video demonstrates the step-by-step implementation of O-arm navigation with endoscopy and its precise execution.

Citations

Citations to this article as recorded by  Crossref logo
  • Arthroscopic-assisted uni-portal spinal surgery technology in the treatment of far-out syndrome: A case report and literature review
    Yuanmeng Chen, Heng Bi, Wei Zhang, Junyi Xiang, Benjing Yin, Chang Liu, Yu Lu
    Journal of International Medical Research.2026;[Epub]     CrossRef
  • O‐Arm Navigation Enhances Facet Preservation Without Compromising Clinical Outcomes in UBE Decompression for Radiographically Stable Adult Degenerative Scoliosis: A Single‐Center Comparative Study
    Yi Liu, Yiwei Xie, Zhibao Chen, Ruijun Xu, Haojie Chen, Xiaojian Ye, Jiangming Yu
    Orthopaedic Surgery.2026; 18(6): 1203.     CrossRef
  • Unilateral Biportal Endoscopic en Bloc Resection of the Lumbosacral Ligament Following Bony Release: A Technique Aiming to Reduce Dorsal Root Ganglion Manipulation
    Cheng-Ying Lee, Cheol-Wung Park, Man-Kyu Park, Wei-Yu Lee, Chien-Min Chen
    Journal of Clinical Medicine.2026; 15(10): 3765.     CrossRef
  • O-arm navigation-guided uni-portal non-coaxial spinal endoscopic surgery for the precise treatment of far-out syndrome—a case report and literature review
    Kai Lv, Dong Zhang, Xinhe Wang, Qiugen Wang, Zhichao Ge, En Song, Hao Sun, Mencheng Yin, Jiajun Wu, Shuqiang Wang, Jianmin Li
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • O-arm navigation-based transforaminal unilateral biportal endoscopic discectomy for upper lumbar disc herniation: an innovative preliminary study
    Dong Hyun Lee, Choon Keun Park, Jin-Sung Kim, Jin Sub Hwang, Jin Young Lee, Dong-Geun Lee, Jae-Won Jang, Jun Yong Kim, Yong-Eun Cho, Dong Chan Lee
    Asian Spine Journal.2025; 19(2): 194.     CrossRef
  • Full-endoscopic Spine Surgery for the Treatment of Far-out Syndrome: A Case Series
    Ryuichi WATANABE, Ryoji TOMINAGA, Kento TAKEBAYASHI, Yasushi OSHIMA, Hiroki IWAI, Hisashi KOGA
    Neurologia medico-chirurgica.2025; 65(12): 583.     CrossRef
  • 5,048 View
  • 184 Download
  • 8 Web of Science
  • 6 Crossref

Video Articles: Special Issue With JMISST

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Hybrid Endoscopic Thoracic Discectomy Using Robotic Arm and Navigation for Highly Migrated Calcified Disc Herniation
Neurospine. 2024;21(4):1126-1130.   Published online December 31, 2024
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Hybrid Endoscopic Thoracic Discectomy Using Robotic Arm and Navigation for Highly Migrated Calcified Disc Herniation
Neurospine. 2024;21(4):1126-1130.   Published online December 31, 2024
Close
This video provides a step-by-step guide for performing the hybrid endoscopic thoracic discectomy using navigation and robotic arm for addressing high migrated calcified disc herniation. With the development of techniques, endoscopic spine surgery has emerged as a reliable treatment for thoracic myelopathy. This approach offers high-resolution, off-axis visualization of the surgical field. The field is poised to advance further as endoscopic instruments are refined, becoming less invasive and more precise through the integration of navigation and robot-assisted systems. A 62-year-old woman presented to us with chief complaints of both legs weakness. She had difficulty standing and walking after squatted due to weakness in her legs and her Oswestry Disability Index score was 66. On examination her both side knee extension and ankle dorsiflexion were grade 4 without dysesthesia. The imaging examination confirmed the diagnosis of thoracic myelopathy caused by a highly migrated calcified disc herniation at T5–6 level. The patient underwent an endoscopic thoracic discectomy using robotic arm and navigation for addressing highly migrated calcified disc herniation, resulting in an excellent outcome. The continuous development of navigation and robotic systems in endoscopic thoracic surgery enhanced accuracy in surgical incisions and instrument placement, as well as improved efficiency in locating pathology and achieving precise decompression. Endoscopic thoracic discectomy combines full-endoscopy and unilateral biportal endoscopic (UBE) techniques to leverage the benefits of both approaches, including the cross-viewing of full-endoscopy cannula and the use of larger Kerrison rongeurs under UBE.

Citations

Citations to this article as recorded by  Crossref logo
  • Multiple imaging-assisted Unilateral biportal endoscopy (UBE) for syringomyelia secondary to T11-12 ligamentum flavum ossification: A case report
    Yue Tian, Hao Li, Fuming Tian, Hongen Bao
    Asian Journal of Surgery.2026; 49(7): 4153.     CrossRef
  • A Commentary on “International Practice Patterns in the Surgical Management of Primary Lumbar Disc Herniation: An AO Spine Cross-Sectional Study”
    Jin-Sung Kim
    Neurospine.2026; 23(1): 40.     CrossRef
  • A preliminary descriptive study on the histology of giant calcified disc herniations: a case series
    Riccardo Cecchinato, Alessandra Colombini, Barbara Rubino, Daniele Vanni, Luca Maria Sconfienza, Pedro Berjano
    European Spine Journal.2026;[Epub]     CrossRef
  • O-arm navigation-based transforaminal unilateral biportal endoscopic discectomy for upper lumbar disc herniation: an innovative preliminary study
    Dong Hyun Lee, Choon Keun Park, Jin-Sung Kim, Jin Sub Hwang, Jin Young Lee, Dong-Geun Lee, Jae-Won Jang, Jun Yong Kim, Yong-Eun Cho, Dong Chan Lee
    Asian Spine Journal.2025; 19(2): 194.     CrossRef
  • Bilateral–Contralateral Endoscopic Decompression as a Fusion-Deferral Strategy in Upper Lumbar Stenosis: A Structural Rationale and Conditional Framework—A Technical Note with Cases Review
    Dong Hyun Lee, Sang Yeop Han, Seung Young Jeong, Il-Tae Jang
    Journal of Clinical Medicine.2025; 14(16): 5726.     CrossRef
  • 4,906 View
  • 133 Download
  • 5 Web of Science
  • 5 Crossref

Video Articles: Special Issue With JMISST

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C7–T1 Full-Endoscopic Posterior Foraminotomy and Sequestrectomy Using Navigation
Neurospine. 2024;21(4):1168-1171.   Published online December 31, 2024
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C7–T1 Full-Endoscopic Posterior Foraminotomy and Sequestrectomy Using Navigation
Neurospine. 2024;21(4):1168-1171.   Published online December 31, 2024
Close
The main objective of this case and video is to demonstrate the surgical technique of navigated full-endoscopic decompression and sequestrectomy at the C7–T1 level to alleviate C8 nerve root compression and manage cervicobrachialgia. Cervicobrachialgia resulting from C7–T1 disc herniation is a quite rare yet painful condition that can significantly impair motor function in the upper limb. Traditionally, open surgeries can be invasive, with prolonged recovery times and/or fusion of the level with adjacent segment disease. Posterior full-endoscopic approach offers a minimally invasive alternative that allows for quicker recovery, less postoperative pain, and improved outcomes. By preserving motion, it also prevents adjacent segment disease. A 72-year-old female presented with sudden-onset cervicobrachial pain radiating to the ulnar side of the right arm, coupled with paresthesia and weakness of the flexors/interosseous muscles (Medical Research Council=M3). Magnetic resonance imaging confirmed a large right-sided C7–T1 disc herniation compressing the C8 nerve root. A full-endoscopic C7–T1 posterior foraminotomy and sequestrectomy was performed with navigation. The patient experienced immediate relief from pain and improved motor function in the right hand postoperatively. Posterior full-endoscopic foraminotomy and sequestrectomy of the C7–T1 disc herniation is effective for treating cervicobrachialgia due to C8 nerve compression. The minimally invasive approach demonstrated in this video highlights the technique and stresses the advantage of navigation in the lower cervical spine.

Citations

Citations to this article as recorded by  Crossref logo
  • Delta large-channel endoscopy versus unilateral biportal endoscopy for cervicothoracic junction disc herniation: a prospective randomized controlled trial
    Huaibin Wang, Hui Li, Rushuo Wei, Hao Yan, Ruzhan Yao, Weiqiang Liu, Ling Li
    Journal of Orthopaedic Surgery and Research.2026;[Epub]     CrossRef
  • Técnica endoscópica interlaminar asistida por navegación para hernia discal C7-T1: abordaje mínimamente invasivo de la unión cervicotorácica. Reporte de caso
    José Carlos Sauri-Barraza, Eduardo Callejas-Ponce, Jorge Daniel Pérez-Ruiz, Luis Enrique Núñez-Alvarado, Luis Alfonso Castillejo-Adalid, Francisco García-Muñoz, Omar Castillejo-Adalid, Adrián Francisco Méndez-Delgado
    Cirugía de Columna.2026; 4(3): 252.     CrossRef
  • 9,420 View
  • 148 Download
  • 1 Web of Science
  • 2 Crossref

Original Article

Regular Issue

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A Self-Developed Mobility Augmented Reality System Versus Conventional X-rays for Spine Positioning in Intraspinal Tumor Surgery: A Case-Control Study
Neurospine. 2024;21(3):984-993.   Published online September 30, 2024
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A Self-Developed Mobility Augmented Reality System Versus Conventional X-rays for Spine Positioning in Intraspinal Tumor Surgery: A Case-Control Study
Neurospine. 2024;21(3):984-993.   Published online September 30, 2024
Close
Objective
To evaluate the efficacy of a self-developed mobile augmented reality navigation system (MARNS) in guiding spinal level positioning during intraspinal tumor surgery based on a dual-error theory.
Methods
This retrospective study enrolled patients diagnosed with intraspinal tumors admitted to Fujian Provincial Hospital between May and November 2023. The participants were divided into conventional x-rays and self-developed MARNS groups according to the localization methods they received. Position time, length of intraoperative incision variation, and location accuracy were systematically compared.
Results
A total of 41 patients (19 males) with intraspinal tumors were included, and MARNS was applied to 21 patients. MARNS achieved successful lesion localization in all patients with an error of 0.38±0.12 cm. Compared to x-rays, MARNS significantly reduced positioning time (129.00±13.03 seconds vs. 365.00±60.43 seconds, p<0.001) and length of intraoperative incision variation (0.14 cm vs. 0.67 cm, p=0.009).
Conclusion
The self-developed MARNS, based on augmented reality technology for lesion visualization and perpendicular projection, offers a radiation-free complement to conventional x-rays.
  • 5,484 View
  • 90 Download

Review Article

Special Issue on AI & Robotics

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Navigation-Guided/Robot-Assisted Spinal Surgery: A Review Article
Neurospine. 2024;21(1):8-17.   Published online March 31, 2024
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Navigation-Guided/Robot-Assisted Spinal Surgery: A Review Article
Neurospine. 2024;21(1):8-17.   Published online March 31, 2024
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The development of minimally invasive spinal surgery utilizing navigation and robotics has significantly improved the feasibility, accuracy, and efficiency of this surgery. In particular, these methods provide improved accuracy of pedicle screw placement, reduced radiation exposure, and shortened learning curves for surgeons. However, research on the clinical outcomes and cost-effectiveness of navigation and robot-assisted spinal surgery is still in its infancy. Therefore, there is limited available evidence and this makes it difficult to draw definitive conclusions regarding the long-term benefits of these technologies. In this review article, we provide a summary of the current navigation and robotic spinal surgery systems. We concluded that despite the progress that has been made in recent years, and the clear advantages these methods can provide in terms of clinical outcomes and shortened learning curves, cost-effectiveness remains an issue. Therefore, future studies are required to consider training costs, variable initial expenses, maintenance and service fees, and operating costs of these advanced platforms so that they are feasible for implementation in standard clinical practice.

Citations

Citations to this article as recorded by  Crossref logo
  • Digital Twin Framework for Spine Surgery Considering Respiratory Motions: Methodology and Proof-of-Concept Validation
    Ashkan Ghorbanian, Borhan Beigzadeh
    IEEE Access.2026; : 1.     CrossRef
  • Obstacles to Spine Surgery in Limited-Resource Environments
    Amer Sebaaly, Mohammad Daher, Joseph E. Nassar, Gaby Kreichati, Khalil Kharrat, Alan H. Daniels
    Journal of Bone and Joint Surgery.2026; 108(7): 477.     CrossRef
  • Novel 3D-navigated screw corridors for posterior pelvic ring stabilization: a finite element analysis
    Eftychios Bolierakis, Maximilian Praster, Hatem Alabdulrahman, Ulf Krister Hofmann, Christian Herren, Roman Michalik, Michel Teuben, Hans-Christoph Pape, Frank Hildebrand, Till Berk
    European Journal of Trauma and Emergency Surgery.2026;[Epub]     CrossRef
  • Preoperative Surgical Planning for Lumbar Spine Pedicle Screw Placement Using PointNet
    Seokbin Hwang, Suk-Joong Lee, Sungmin Kim
    Electronics.2026; 15(2): 468.     CrossRef
  • Robotics in Cervical Spine Surgery: The Current Scenario
    S. Vidyadhara, Abhishek Soni, T. Balamurugan, H. S. Chhabra
    Indian Spine Journal.2026; 9(1): 12.     CrossRef
  • Robotic Thoracolumbar Pedicle Screw Fixation: A Comprehensive Narrative Review
    Anuj Mundra, Sachin Sharma, Vishal Singh, S. Vidyadhara, Harvinder Singh Chhabra
    Indian Spine Journal.2026; 9(1): 61.     CrossRef
  • Three-dimensional Printing in Spine Surgery: A Comprehensive Review of Current Applications, Outcomes, and Future Directions
    Manish Gupta, Bhavuk Garg
    Indian Spine Journal.2026; 9(1): 72.     CrossRef
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    Kamran Shirbache, Melika Heidarzadeh, Reihane Qahremani, Amin Karami, Shaghayegh Karami, Elham Madreseh, Julio J. Jauregui, Ebrahim Najafzadeh, Ali Kazemi, Mohammad Hossein Nabian
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    Shuai Li, Jinpeng Du, Xiaohui Wang, Yunfei Huang, Yansheng Huang, Zhen Chang, Liang Yan, Xuefang Zhang, Zhengwei Shi, Zhigang Zhao, Lin Gao, Songchuan Zhao, Baorong He
    European Spine Journal.2025; 34(3): 1004.     CrossRef
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    Luthfi Gatam, Phedy Phedy, Syafruddin Husin, Harmantya Mahadhipta, Asrafi Rizki Gatam, Mitchel Mitchel, Karina Sylvana Gani, Erica Kholinne
    Frontiers in Surgery.2025;[Epub]     CrossRef
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    Esteban Quiceno, Mohamed A. R. Soliman, Asham Khan, Jeffrey P. Mullin, John Pollina
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    Jonathan Hammond, Stefano Priola
    Interdisciplinary Neurosurgery.2025; 40: 102056.     CrossRef
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    Debarghya China, Luke J. MacLean, Jinchi Wei, Nicholas Theodore, Norbert Johnson, Neil Crawford, Kai Ding, Ali Uneri
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    Sadayuki Ito, Shiro Imagama, Hiroaki Nakashima, Masaaki Machino, Toshinori Sakai, Toshimi Aizawa, Hideyuki Arima, Hideaki Hamanaka, Yuyu Ishimoto, Satoshi Kato, Yoshiharu Kawaguchi, Hiroaki Konishi, Naohisa Miyakoshi, Hideki Murakami, Yukitaka Nagamoto, K
    European Spine Journal.2025; 34(8): 3095.     CrossRef
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    Asrafi Rizki Gatam, Luthfi Gatam, Ajiantoro Ajiantoro, Omar Luthfi, Phedy Phedy, Harmantya Mahadhipta, Syafruddin Husin, Karina Sylvana Gani, Mitchel Mitchel, Erica Kholinne
    Frontiers in Surgery.2025;[Epub]     CrossRef
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    Kangheng Niu, Zhenzhen Tao, Le Cheng, Zhong Wei, Hui Kang, Tanjun Wei, Biwang Huang, Feng Xu, Chengjie Xiong
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
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    Nora C. Kim, Eli Johnson, Christopher DeWald, Nathan Lee, Timothy Y. Wang
    Journal of Clinical Medicine.2025; 14(15): 5377.     CrossRef
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    Contemporary Spine Surgery.2025; 26(9): 1.     CrossRef
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    Wenjie Zheng, Junlong Wu, Wen Xia, Rui Zuo, Xian Chang, Hong Yin, Changqing Li, Chao Zhang
    Journal of Pain Research.2025; Volume 18: 4361.     CrossRef
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  • 25,354 View
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  • 60 Web of Science
  • 64 Crossref

Original Articles

Special Issue on AI & Robotics

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Advancements and Challenges in Robot-Assisted Bone Processing in Neurosurgical Procedures
Neurospine. 2024;21(1):97-103.   Published online March 31, 2024
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Advancements and Challenges in Robot-Assisted Bone Processing in Neurosurgical Procedures
Neurospine. 2024;21(1):97-103.   Published online March 31, 2024
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Objective
Practical applications of nerve decompression using neurosurgical robots remain unexplored. Our ongoing research and development initiatives, utilizing industrial robots, aim to establish a secure and efficient neurosurgical robotic system. The principal objective of this study was to automate bone grinding, which is a pivotal component of neurosurgical procedures.
Methods
To achieve this goal, we integrated an endoscope system into a manipulator and conducted precision bone machining using a neurosurgical drill, recording the grinding resistance values across 3 axes. Our study encompassed 2 core tasks: linear grinding, such as laminectomy, and cylindrical grinding, such as foraminotomy, with each task yielding unique measurement data.
Results
In linear grinding, we observed a proportional increase in grinding resistance values in the machining direction with acceleration. This observation suggests that 3-axis resistance measurements are a valuable tool for gauging and predicting deep cortical penetration. However, problems occurred in cylindrical grinding, and a significant error of 10% was detected. The analysis revealed that multiple factors, including the tool tip efficiency, machining speed, teaching methods, and deflection in the robot arm and jig joints, contributed to this error.
Conclusion
We successfully measured the resistance exerted on the tool tip during bone machining with a robotic arm across 3 axes. The resistance ranged from 3 to 8 Nm, with the measurement conducted at a processing speed approximately twice that of manual surgery performed by a surgeon. During the simulation of foraminotomy under endoscopic grinding conditions, we encountered a -10% error margin.

Citations

Citations to this article as recorded by  Crossref logo
  • Recent advances in robotic-assisted laminectomy in spine surgery: a narrative review
    Tarun Mattikalli, Konstantinos Margetis, James D. Lin, Jeremy Steinberger
    Asian Spine Journal.2026; 20(2): 388.     CrossRef
  • Thermal performance of modified surgical drill margins during bone drilling: An experimental, numerical, and optimization case study
    Mohd Faizal Ali Akhbar, Shahrizan Jamaludin, Suriani Mat Jusoh, Fatin Alias, Mohd Azlan Musa, Rodianah Alias
    Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine.2026; 240(4): 411.     CrossRef
  • Optimization of Surgical Drill Margin Dimension to Reduce Bone Temperature
    Mohd Faizal Ali Akhbar, Shahrizan Jamaludin, Rodianah Alias
    Key Engineering Materials.2026; 1053: 27.     CrossRef
  • Force model of robot bone grinding based on finite element analysis
    Kai Yang, Qingxuan Jia, Chao Feng, Juxiang Huang, Gang Chen, Zheng Yang
    Measurement.2025; 243: 116124.     CrossRef
  • Step-coated FBG and runway-shaped beam 6-D F/T sensor with dynamic self-fault-tolerant for orthopedic surgery robot
    Chen Zhao, Tianliang Li, Haolei Fan, Haotian Zhou, Jun wang, Yu Xu, Hongliang Ren, Fei Cheng, Yuegang Tan, Zude Zhou
    The International Journal of Robotics Research.2025; 44(12): 2073.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the March 2024 Issue
    Inbo Han
    Neurospine.2024; 21(1): 1.     CrossRef
  • Expanding the Scope of Robotic Spinal Surgery With Bone Decompression: Commentary on “Advancements and Challenges in Robot-Assisted Bone Processing in Neurosurgical Procedures”
    Stephen Ryu
    Neurospine.2024; 21(1): 104.     CrossRef
  • Commentary on “The Utility and Feasibility of Smart Glasses in Spine Surgery: Minimizing Radiation Exposure During Percutaneous Pedicle Screw Insertion”
    Wongthawat Liawrungrueang
    Neurospine.2024; 21(2): 440.     CrossRef
  • 6,039 View
  • 130 Download
  • 7 Web of Science
  • 8 Crossref

Special Issue on AI & Robotics

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Intraoperative Cone-Beam Computed Tomography Navigation Versus 2-Dimensional Fluoroscopy in Single-Level Lumbar Spinal Fusion: A Comparative Analysis
Neurospine. 2024;21(1):76-82.   Published online March 31, 2024
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Intraoperative Cone-Beam Computed Tomography Navigation Versus 2-Dimensional Fluoroscopy in Single-Level Lumbar Spinal Fusion: A Comparative Analysis
Neurospine. 2024;21(1):76-82.   Published online March 31, 2024
Close
Objective
Several studies have advocated for the higher accuracy of transpedicular screw placement under cone-beam computed tomography (CBCT) compared to conventional 2-dimensional (2D) fluoroscopy. The superiority of navigation systems in perioperative and postoperative outcomes remains a topic of debate. This study aimed to compare operative time, screw placement time and accuracy, total radiation dose, perioperative and postoperative outcomes in patients who underwent transpedicular screw fixation for degenerative lumbar spondylolisthesis (DLS) using intraoperative CBCT navigation versus 2D fluoroscopy.
Methods
A retrospective analysis was conducted on patients affected by single-level DLS who underwent posterior lumbar instrumentation with transpedicular screw fixation using surgical CBCT navigation (NV group) or 2D fluoroscopy-assisted freehand technique (FH group). Demographics, screw placement time and accuracy, operative time, total radiation dose, intraoperative blood loss, screw revision rate, complications, and length of stay (LOS) were assessed.
Results
The study included a total of 30 patients (NV group: n = 15; FH group: n = 15). The mean screw placement time, operative time, and LOS were significantly reduced in the NV group compared to the FH group (p < 0.05). The total radiation dose was significantly higher in the NV group (p < 0.0001). No significant difference was found in terms of blood loss and postoperative complications.
Conclusion
This study suggests that intraoperative CBCT-navigated single-level lumbar transpedicular screw fixation is superior in terms of mean screw placement time, operative time, and LOS compared to 2D fluoroscopy, despite a higher intraoperative radiation exposure.

Citations

Citations to this article as recorded by  Crossref logo
  • Evidence-Based Guidelines for the Surgical Management of Degenerative Lumbar Spondylolisthesis
    Harrison J. Howell, Nathan J. Winans, Dean Chou, Andrew K. Chan
    Neurosurgery Clinics of North America.2026; 37(1): 1.     CrossRef
  • Comparative analysis of the pedicle screw accuracy, screw revision and loosening rate and radiation exposure of robotic-guided (RG), intraoperative computed tomography (iCT)-navigation guided, and fluoroscopy guided placement technique
    Mirza Pojskić, Miriam Bopp, Omar Alwakaa, Christopher Nimsky, Benjamin Saß
    Brain and Spine.2026; 6: 105899.     CrossRef
  • Complications With Navigation-Assistance in Thoraco-Lumbar Spine Surgery
    Takeshi Fujii, Patricia Lipson, Kenneth T. Nguyen, Gianluca Vadalà, Laura Scaramuzzo, Patrick Hsieh, Katie Krause, Sangwook Tim Yoon, Philip K. Louie
    Global Spine Journal.2026;[Epub]     CrossRef
  • Framework for Adoption of Enabling Technologies for Improved Outcomes in Spine Surgery
    Sathish Muthu, Swaminathan Ramasubramanian, Madhan Jeyaraman, Roger Hartl, Javad Tavakoli, Samuel K. Cho, Laura Scaramuzzo, Hardeep Singh, Philip K. Louie, Andreas K. Demetriades, Patrick C. Hsieh, Stipe Ćorluka, Yabin Wu, Xiaolong Chen, Hai V. Le, Gianlu
    Global Spine Journal.2025; 15(6): 2977.     CrossRef
  • Open Versus Minimally Invasive Spine Surgery in the Treatment of Single-Level Degenerative Lumbar Spondylolisthesis: An AO Spine Global Cross-Sectional Study
    Luca Ambrosio, Sathish Muthu, Samuel K. Cho, Micheal S. Virk, Juan P. Cabrera, Patrick C. Hsieh, Andreas K. Demetriades, Stipe Ćorluka, S. Tim Yoon, Gianluca Vadalà
    Neurospine.2025; 22(1): 40.     CrossRef
  • Deviation from preoperative planning and pedicle screw accuracy in navigated and robotic spinal fusion: a systematic review
    Fabrizio Russo, Niccolò Nardi, Giuseppe Francesco Papalia, Rocco Papalia, Gianluca Vadalà, Vincenzo Denaro
    European Spine Journal.2025; 34(5): 1890.     CrossRef
  • 7,406 View
  • 154 Download
  • 6 Web of Science
  • 6 Crossref

Review Article

NASS/Neurospine Endoscopic Spine Surgery Special Issue

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The Role and Future of Endoscopic Spine Surgery: A Narrative Review
Neurospine. 2023;20(1):43-55.   Published online March 31, 2023
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The Role and Future of Endoscopic Spine Surgery: A Narrative Review
Neurospine. 2023;20(1):43-55.   Published online March 31, 2023
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Many types of surgeries are changing from conventional to minimally invasive techniques. Techniques in spine surgery have also changed, with endoscopic spine surgery (ESS) becoming a major surgical technique. Although ESS has advantages such as less soft tissue dissection and normal structure damage, reduced blood loss, less epidural scarring, reduced hospital stay, and earlier functional recovery, it is not possible to replace all spine surgery techniques with ESS. ESS was first used for discectomy in the lumbar spine, but the range of ESS has expanded to cover the entire spine, including the cervical and thoracic spine. With improvements in ESS instruments (optics, endoscope, endoscopic drill and shaver, irrigation pump, and multiportal endoscopic), limitations of ESS have gradually decreased, and it is possible to apply ESS to more spine pathologies. ESS currently incorporates new technologies, such as navigation, augmented and virtual reality, robotics, and 3-dimentional and ultraresolution visualization, to innovate and improve outcomes. In this article, we review the history and current status of ESS, and discuss future goals and possibilities for ESS through comparisons with conventional surgical techniques.

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Original Articles

NASS/Neurospine Endoscopic Spine Surgery Special Issue

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Navigation-Assisted Full-Endoscopic Radiofrequency Rhizotomy Versus Fluoroscopy-Guided Cooled Radiofrequency Ablation for Sacroiliac Joint Pain Treatment: Comparative Study
Neurospine. 2023;20(1):141-149.   Published online March 31, 2023
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Navigation-Assisted Full-Endoscopic Radiofrequency Rhizotomy Versus Fluoroscopy-Guided Cooled Radiofrequency Ablation for Sacroiliac Joint Pain Treatment: Comparative Study
Neurospine. 2023;20(1):141-149.   Published online March 31, 2023
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Objective
Sacroiliac joint (SIJ) pain is a common cause of chronic low back pain. Full-endoscopic rhizotomy of lateral branches of dorsal rami innervating SIJ is a potential option for patients’ refractory to medical treatment. The full-endoscopic rhizotomy is sometimes challenging under fluoroscopic guidance. This study is to evaluate the effectiveness of the navigation-assisted full-endoscopic rhizotomy for SIJ pain.
Methods
The study was a retrospective match-paired study that enrolled consecutive patients undergoing navigation-assisted full-endoscopic rhizotomy for SIJ pain. The patient demographics, clinical outcomes, and operative parameters of endoscopic rhizotomy were compared with conventional cooled radiofrequency ablation (RFA) treatment.
Results
The study enrolled 72 patients, including 36 patients in the endoscopic group. Thirty-six patients in the cooled RFA group were matched by age as the control. The follow-up time was at least 1 year. Patient characteristics were similar between the groups. The navigation-assisted endoscopic rhizotomy operation time was significantly longer than the cooled RFA. The visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) significantly decreased after each treatment. However, the between-group comparison revealed that the VAS and ODI of the patients after endoscopic rhizotomy were significantly lower than those after the cooled RFA group. There were no postoperative complications in the study.
Conclusion
Navigation-assisted full-endoscopic rhizotomy is an alternative to SIJ pain treatment. Integrating intraoperative navigation can ensure accurate full-endoscopic rhizotomy to provide better durability of pain relief than the cooled RFA.

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Minimally Invasive Spinal Surgery SMISS-Neurospine Special Issue

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Augmented Reality to Improve Surgical Workflow in Minimally Invasive Transforaminal Lumbar Interbody Fusion – A Feasibility Study With Case Series
Neurospine. 2022;19(3):574-585.   Published online September 30, 2022
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Augmented Reality to Improve Surgical Workflow in Minimally Invasive Transforaminal Lumbar Interbody Fusion – A Feasibility Study With Case Series
Neurospine. 2022;19(3):574-585.   Published online September 30, 2022
Close
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.

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Review Article

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Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review
Neurospine. 2022;19(1):163-176.   Published online March 31, 2022
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Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review
Neurospine. 2022;19(1):163-176.   Published online March 31, 2022
Close
Lumbar degenerative disease is a common problem in an aging society. Oblique lateral interbody fusion (OLIF) is a minimally invasive surgical (MIS) technique that utilizes a retroperitoneal antepsoas corridor to treat lumbar degenerative disease. OLIF has theoretical advantages over other lumbar fusion techniques, such as a lower risk of lumbar plexus injury than direct lateral interbody fusion (DLIF). Previous studies have reported favorable clinical and radiological outcomes of OLIF in various lumbar degenerative diseases. The use of OLIF is increasing, and evidence on OLIF is growing in the literature. The indications for OLIF are also expanding with the help of recent technical developments, including stereotactic navigation systems and robotics. In this review, we present current evidence on OLIF for the treatment of lumbar degenerative disease, focusing on the expansion of surgical indications and recent advancements in the OLIF procedure.

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Review and Technical Note

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Posterior Endoscopic Cervical Decompression: Review and Technical Note
Neurospine. 2020;17(Suppl 1):S74-S80.   Published online July 31, 2020
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Posterior Endoscopic Cervical Decompression: Review and Technical Note
Neurospine. 2020;17(Suppl 1):S74-S80.   Published online July 31, 2020
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Endoscopic spine surgery for the treatment of degenerative spinal diseases from lumbar to cervical spine has accelerated over the past 2 decades. Posterior endoscopic cervical discectomy (PECD) has been described as a safe, effective, and minimally invasive procedure for cervical radiculopathy or even part of the myelopathy. This procedure also has been validated with comparable outcomes to open and microscopic surgery. Radiculopathy due to foraminal disc herniation or foraminal stenosis should be the optimum indications of this procedure. Intraoperative 3-dimensional navigation can help surgeons to get quick and great quality guidance for endoscopic surgeons. In this review, we will focus on the technical details and evidence-based results of PECD which is a promising procedure for cervical radiculopathy with the advantages of a minimally invasive method.

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