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Page 19 Martinez et al. Art Int Surg. 2025;5:16-23 https://dx.doi.org/10.20517/ais.2024.73

with hopes of significant alterations to radiologic evaluation. For example, the important work of Wang et
al. proved the clinical utility of applying deep neural networks for the detection of spinal metastasis,
[33]
reaching an accuracy of 90% .

Specifically, within spino-plastics, there are many applications for AI in diagnostics and imaging. Spino-
plastic reconstruction is concerned with (1) increased bony fusion, especially in the setting of previous
failures; (2) decreased time to bony fusion; (3) optimizing the interface between soft tissues, hardware, and
osseous structures in both form and skeletal function; (4) stable and long-term closure of wounds: these are
data points that are amenable to AI application. As mentioned, there is a wide range of pathology
warranting VBGs to augment spinal fusion, including prior failed fusion and extensive reconstruction after
tumor extirpation. A closer and more comprehensive evaluation of radiologic studies might provide insight
into patients that necessitate further intervention to offer a better chance at successful fusion. In addition,
computer modeling based on multidimensional analysis of various imaging modalities might also propose
[34]
the vertebral level incurring the greatest mechanical stress status post instrumentation and fusion , further
aiding the surgical team in deciding the final target for VBG fixation.

This brings us to the discussion of VSP. This technique employs patient imaging to construct a 3D surgical
model that allows for surgical simulation, visualization of complex anatomy, and virtual mapping to assist
[35]
with procedural planning . Over the past several decades, VSP has been widely adopted within
orthognathic surgery, providing an alternative to traditional surgical planning techniques . VSP improves
[36]
surgical accuracy, creating more symmetry than would have otherwise been possible without this
technology . Therefore, VSP is trusted by orthognathic surgeons who operate in a field where aesthetic
[36]
results are of paramount importance . While there is still much room for growth in this surgical tool, it has
[36]
[37]
been suggested that AI will only increase the scope of VSP . In a recent 2023 study, Browd et al. describe
how patient-specific quantitative metrics, such as bone density, sagittal balance, and Cobb angles, derived
from imaging modalities can potentially be applied to AI and ML algorithms for better surgical planning .
[26]
INTRAOPERATIVE UTILIZATION
Intraoperatively, AI can be very helpful in tumor resection and reconstruction of the spine. For instance, AI
can assist surgeons in differentiating between normal tissue and glioblastoma multiforme . Alternatively,
[38]
AI might be harnessed to improve existing technology and intraoperative decision making. Many devices
and techniques have been described for improved intraoperative performance in spine surgery. Computer-
[23]
assisted navigation systems such as stealth guidance assist in surgical planning and operational precision .
Stealth guidance is a robotic technology that enhances intraoperative localization and accuracy through
three-dimensional modeling . Stealth guidance systems such as Medtronic’s StealthStation employ
[39]
imaging data in the form of MRI and CT scans to create multidimensional anatomic models and real-time
navigation that allows surgeons to know precisely where they are in space [40,41] . The precision enhancement
of robotic-assisted stealth guidance has been demonstrated to reduce operative times and decrease intra-
and postoperative complications in neurosurgical and spinal procedures requiring a higher level of dexterity
and accuracy [42-44] .

Another distinct piece of computer-assisted navigation systems that improve operative efficacy is
augmented reality (AR). This technology assists with intraoperative navigation by overlaying graphics in the
real world, enhancing the perception of surgical instruments in space [45,46] . By incorporating an overlay of
surgical plans or highlighting relevant anatomy, surgeons are provided with real-time information that
enhances their visualization and proprioception without the need to divert their attention away from the
patient toward a screen . AR has been integrated into fields like orthopedic surgery, trauma surgery, and
[47]