An Emory Healthcare neurosurgery team led by Daniel Refai, MD, professor in the Department of Neurosurgery at Emory University School of Medicine, has completed what is believed to be the world’s first continuously navigated endoscopic transforaminal lumbar interbody fusion (TLIF), a minimally invasive procedure used to treat certain conditions affecting the lower spine. The first case was successfully completed at Emory University Hospital Midtown in May.
In endoscopic spine surgery, surgeons use a small camera and specialized instruments inserted through small openings to see and work inside the body. In this procedure, Emory surgeons combined endoscopic visualization with real-time surgical navigation throughout the operation. Navigation remained active from planning the incision and accessing the spine to preparing the disc space, placing the implant and securing the screws. The approach gives surgeons continuous guidance during a complex procedure and helps them stay targeted while working through small surgical openings.
“This is an important advancement for minimally invasive spine surgery,” says Refai. “Continuous navigation helps the surgical team stay oriented throughout the procedure, supporting precision and accuracy while limiting disruption to surrounding tissue.”
A TLIF is used to stabilize the spine by removing a damaged disc and placing an implant between two vertebrae to help restore alignment and promote fusion. While traditional spine navigation is often used at specific points during surgery, navigation remained active throughout this endoscopic procedure.
The approach is designed to support several potential advantages of minimally invasive spine surgery, including smaller incisions, less tissue disruption, reduced reliance on fluoroscopy and improved accuracy in screw placement. By keeping navigation active throughout the case, the technology may also help create more reproducible workflows and make advanced endoscopic techniques easier for more surgeons to adopt over time.
The procedure was performed using Amplify Surgical’s dualPortal and dualX platform, Stryker navigation and endoscopy technologies and VB Spine instrumentation. The case is part of a growing move toward more integrated, image-guided and minimally invasive approaches in spine surgery.
“Endoscopic spine surgery requires surgeons to work through a small opening with a very focused view, which can make it technically challenging,” Refai says. “Continuous navigation adds a live map to that view, helping us understand where we are in relation to the patient’s anatomy as the procedure moves forward.”
More study is needed to understand how the new approach may affect patient outcomes, operating room efficiency and broader adoption.The procedure is part of Emory’s continued focus on advancing neurosurgical care through new techniques, research and training.
