• Akihiko Hiyama, Hiroyuki Katoh, Daisuke Sakai, and Masahiko Watanabe.
• Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan. Electronic address: a.hiyama@tokai-u.jp.
• World Neurosurg. 2021 Feb 1; 146: 232-239.

BackgroundWe describe a new technique that combines navigation-assisted extreme lateral interbody fusion (NALIF) and percutaneous placement of pedicle screws in the lateral decubitus position with the surgeon using wearable smart glasses.MethodsWe explain our method for nonfluoroscopic NALIF and single-position (SP)- percutaneous pedicle screw (PPS) surgery for patients with degenerative lumbar diseases using wearable smart glasses. The wearable smart glasses provide a semitransparent overlay of the navigation information onto the image seen through the lenses. This technique does not require fluoroscopy during lateral interbody fusion or PPS insertion. It is convenient because it does not require a Jamshidi needle or guidewire when inserting PPSs.ResultsUsing this method, the surgeon can glance at the 3-dimensional images on the wearable smart glasses while still viewing the operation field. A review of 24 cases yielded an average operation time of 89.5 ± 16.4 minutes and 66.7 ± 67.0 mL of blood loss, without any severe intra- or postoperative complications.ConclusionsNonfluoroscopic NALIF and SP-PPS placement surgery is a safe and effective means for implanting cages and PPSs in this minimally invasive approach without compromising the results. Although further investigations are needed, the wearable smart glasses may be a useful surgical aid when performing NALIF and SP-PPS placement in patients with degenerative lumbar diseases.Copyright © 2020 Elsevier Inc. All rights reserved.

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