Here, we highlight the use of virtual live fluoroscopy in prone lateral spine surgery. The illustrative case consists of a 75-year-old male presenting with prior L3-L5 fusion and progressive lower extremity pain and weakness. Utilizing the described techniques, the patient underwent a lateral retroperitoneal interbody fusion and posterior instrumentation at L2/L3. The operation proceeded without complication and the patient reported improved ambulation at 6 weeks follow-up. The prone lateral transpsoas approach and minimally-invasive posterior instrumentation for lumbar interbody fusion permits effective fusion without significant posterior muscle disruption from a single position. The integration of virtual live fluoroscopy enables real-time instrument tracking throughout the minimally-invasive case, with reductions in patient and surgeon radiation exposure. The following video depicts the use and benefits of this technology in lateral spine surgery.