Augmented reality in non-instrumentation minimally invasive spine surgery: a narrative review and future perspectives.

Abstract

<h4>Background and objective</h4>Augmented reality (AR) is being increasingly integrated into spine surgery. However, most existing reviews predominantly focus on its use in instrumentation-based procedures. The broader role of AR in of non-instrumentation minimally invasive spine surgery (MISS), including decompression, endoscopic, and tubular techniques, has not been fully synthesized. This narrative review aims to bring together the current evidence on AR applications across the full range of MISS, with a particular focus on visualization- and workflow-critical non-instrumentation procedures, an area that has been underrepresented in prior reviews.<h4>Methods</h4>A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library for articles published between 2010 and 2025. Search terms included Medical Subject Headings (MeSH) and free-text keywords related to augmented reality, minimally invasive spine surgery, decompression, and navigation. Only peer-reviewed English-language articles were included. Study selection was performed independently by three reviewers, with discrepancies resolved by consensus.<h4>Key content and findings</h4>The review synthesizes AR applications across percutaneous procedures, tubular surgery, endoscopic spine surgery (ESS), microscopic surgery, and lateral approaches. The literature indicates that AR can enhance intraoperative visualization through <i>in-situ</i> image overlays, reduce visual attention shifts and cognitive workload, improve workflow efficiency, and lower radiation exposure. However, current evidence is largely derived from small-sample, single-center feasibility studies (levels IV-V evidence). Comparative analyses suggest AR is most valuable as a complementary visualization layer within multimodal navigation ecosystems rather than a standalone replacement.<h4>Conclusions</h4>AR represents a promising adjunct in MISS, particularly for non-instrumentation procedures in which visualization is limited. To define its definitive clinical value, future research must prioritize workflow standardization, validation of performance metrics, and adequately powered multicenter trials that assess clinically meaningful outcomes. Integration with artificial intelligence (AI) and robotic platforms may further enhance surgical precision and efficiency, shaping the next phase of MISS.