Integrating Mixed Reality Navigation in Spine Surgery: Experience from a National Spinal Injuries Unit and Logistical-Economic Analysis

Premier Science > Integrating Mixed Reality Navigation in Spine Surgery: Experience from a National Spinal Injuries Unit and Logistical-Economic Analysis

Listen

Arnav Barve¹ , Dave Moore², Jake McDonnell¹, Katherine Egan¹, Kevin Clesham², Horea Pop¹, Keith Synnott¹, Sam Lynch¹, Marcus Timlin¹, Seamus Morris¹, Stacey Darwish¹ and Joseph Butler¹
1.National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
2. Royal College of Surgeons in Ireland, Dublin, Ireland
Correspondence to: Arnav Barve, arnav.barve@ucdconnect.ie

DOI: https://doi.org/10.70389/PJS.100193

Additional information

Ethical approval: N/a
Consent: N/a
Funding: No industry funding
Conflicts of interest: N/a
Author contribution: Various as shown
Guarantor: Arnav Barve
Provenance and peer-review: Unsolicited and externally peer-reviewed
Data availability statement: N/a

Keywords: Mixed reality spine navigation, Posterior spinal instrumentation, Brainlab navigation system, Intraoperative 3d overlay workflow, Logistical-economic analysis.

Peer Review
Received: 20 November 2025
Accepted: 24 November 2025
Version accepted: 1
Published: 27 December 2025

VRiMS Inaugural Conference Abstract

Plain Language Summary Infographic

“Infographic poster presenting clinical experience with mixed reality navigation in posterior spine surgery, depicting three-dimensional anatomical overlays, percutaneous stabilisation and tumour resection benefits, workflow feasibility, hardware accuracy, and a three-year economic analysis demonstrating low logistical burden.”

Abstract

Introduction: Mixed Reality (MR) navigation overlays three-dimensional anatomical reconstructions into the surgeon’s operative field. This study presents a case series describing the clinical application, workflow integration, and logisticaleconomic considerations of the Brainlab Spine MR Navigation System in spinal surgery.

Methods: A retrospective review was performed using data from all spinal procedures completed with the Brainlab MR navigation platform between September 2024 and March 2025. Fifteen patients underwent posterior procedures, including trauma, degenerative, oncologic, and deformity cases. Operative approach, levels fused, use of minimally invasive techniques, setup time, and intraoperative workflow integration were documented. Postoperative imaging was reviewed for hardware placement and alignment.

Results: MR was implemented in six trauma, five degenerative, three oncologic, and one deformity case. Four procedures (27%) used percutaneous techniques. The mean number of levels fused was 2.9 (range 1–8). The MR system added approximately 3–5 minutes for registration, with headset re-registration required in three cases, resolved without significant delay. No intraoperative complications were attributable to MR use. Postoperative imaging confirmed correct hardware positioning and satisfactory alignment in all patients. Surgeons reported benefit in percutaneous stabilisations and tumour resections from continuous 3D overlays. The 3-year cost for a dual-headset system was €59,660 with no ongoing per-case consumable costs.

Conclusions: This study demonstrates the feasibility and safety of MR navigation in posterior spinal procedures. The system integrates efficiently into existing workflows, enhances spatial awareness, and may offer particular value in minimally invasive and tumour cases. Further prospective studies are required to assess outcomes, cost-effectiveness, and broader adoption potential.

Cite this article as:
Barve A, Moore D, McDonnell J, Egan K, Clesham K, Pop H, Synnott K, Lynch S, Timlin M, Morris S, Darwish S and Butler J. Integrating Mixed Reality Navigation in Spine Surgery: Experience from a National Spinal Injuries Unit and Logistical-Economic Analysis. Premier Journal of Science 2025;14:100193