Anterior lumbar interbody fusion (ALIF), traditionally performed supine, allows for significant restoration of lumbar lordosis, disc height, and foraminal height in degenerative spine pathologies; however, an iatrogenic injury to viscera and the great vessels can have devastating consequences. While lateral lumbar interbody fusion (LLIF) is an acceptable and minimally invasive alternative at the L5-S1 level, this approach is suboptimal due to a narrow surgical corridor limited by the iliac crest, common iliac artery and vein, and psoas. Furthermore, combining supine L5-S1 ALIF and lateral decubitus LLIF (LD-LLIF) requires a time-consuming patient re-positioning.1,2 To maximize the advantages of both procedures in patients with pathology spanning the lumbosacral junction, ALIF and LLIF can be performed in a single stage with the patient remaining in a LD position throughout. To improve the efficiency of this single-position procedure, a fluoroscopy-based instrument tracking system (TrackX Technology Inc., Hillsborough, NC) was utilized to navigate surgical tools during the procedure. We demonstrate this technique in a 43-year-old patient with medically intractable back and leg pain secondary to multi-level degenerative lumbar spondylosis. The patient consented to this procedure; all participants consented to publication of their images. This tracking system allowed for accurate and precise virtual projections of surgical instruments facilitating the identification of midline and proper trajectories to perform discectomy and implant placement, while reducing the amount of intra-operative fluoroscopy usage and eliminating intra-operative CT. To our knowledge, this is the first operative video demonstrating a fluoroscopy-based instrument tracking system utilized in a combined single-position LD-ALIF and LD-LLIF.