Comprehensive workflow with optical navigation in minimally invasive transforaminal lumbar interbody fusion: a retrospective study.

Background: Degenerative lumbar diseases (LDD) are increasingly common among the elderly due to extended life expectancy. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a preferred surgical technique for LDD, offering advantages over traditional methods, although it presents technical challenges. In this study, we compared the clinical outcomes and radiological accuracy between optical navigation-assisted MIS-TLIF (OMIS-TLIF) and conventional C-arm navigation-assisted MIS-TLIF (CMIS-TLIF) for the treatment of LDD.

Methods: A retrospective analysis was conducted on 90 patients who underwent single-level lumbar fusion between December 2021 and April 2023. Patients were divided into two groups: 36 underwent OMIS-TLIF, and 54 underwent CMIS-TLIF. The surgical duration, blood loss, hospital stay, complication rates, and clinical outcomes were assessed. Radiological parameters, such as pedicle screw placement accuracy and facet joint violation (FJV) rates, were also evaluated. The learning curves for surgical time were analyzed using the Cumulative Sum Control Chart method.

Results: OMIS-TLIF demonstrated a significantly shorter total operation time (125.25 ± 19.51 min) compared with CMIS-TLIF (136.41 ± 20.39 min,  < 0.05). OMIS-TLIF also achieved higher accuracy in pedicle screw placement (99.31% vs. 96.76%,  < 0.05) and lower FJV rates (91.67% vs. 81.48%,  < 0.05). Significantly lower pain scores (VAS) and improved functional outcomes (ODI) was observed at the 1-week follow-up ( < 0.05), although no significant differences were noted at the 3-month and latest follow-ups. The learning curve for OMIS-TLIF showed proficiency after 14 cases, whereas CMIS-TLIF required 27 cases to achieve similar proficiency.

Conclusion: The optical navigation system enhances the precision and efficiency of MIS-TLIF. OMIS-TLIF demonstrated superior clinical outcomes compared with CMIS-TLIF, with improved accuracy of instrument placement, a shorter surgery times and learning curve. These findings suggest that OMIS-TLIF offers significant advantages for the treatment of LDD.

Supplementary Information: The online version contains supplementary material available at 10.1186/s13018-025-06111-5.