Use of navigation to optimize awake prone lateral interbody fusion with posterior decompression and fusion.

This video demonstrates the role of navigation in optimizing awake single-position prone lateral transpsoas interbody fusion with simultaneous posterior decompression and instrumentation under spinal anesthesia. Awake spine surgery is constrained by the duration of spinal anesthesia and demands a coordinated workflow, making navigation essential. The patient was a 77-year-old man with significant cardiac comorbidities and neurogenic claudication from severe L3-4 stenosis. Technical pearls are presented addressing navigational accuracy in the conscious patient and strategies promoting near-simultaneous workflow between the lateral and posterior approaches. Navigation supports both procedural accuracy and workflow efficiency throughout the case. The video can be found here: https://stream.cadmore.media/r10.3171/2026.4.FOCVID25238.