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Review
. 2025 Oct;18(10):398-405.
doi: 10.1007/s12178-025-09972-9. Epub 2025 Apr 30.

Artificial Intelligence in Spine Surgery: Imaging-Based Applications for Diagnosis and Surgical Techniques

James S MacLeod  1   2 , Tyler Compton  3 , Yianni Bakaes  3   4 , Avani Chopra  3   4 , Frances Akwuole  3   4 , Cole Christenson  3   4 , Wellington Hsu  3   4
Affiliations
Review

Artificial Intelligence in Spine Surgery: Imaging-Based Applications for Diagnosis and Surgical Techniques

James S MacLeod et al. Curr Rev Musculoskelet Med. 2025 Oct.

Abstract

Purpose of review: Artificial intelligence (AI) has rapidly proliferated though medicine with many novel applications to improve patient care and optimize healthcare delivery. This review investigates recent literature surrounding the influence of AI imaging technologies on spine surgical practice and diagnosis.

Recent findings: Robotic-assisted pedicle screw placement has been shown to increase the rate of clinically acceptable screw placement while increasing operative time. AI technologies have also shown promise in creating 3D spine imaging while reducing patient radiation exposure. Several models using various imaging modalities have been shown to reliably identify vertebral osteoporotic fractures, stenosis and spine cancers. Complex spinal anatomy and pathology as well as integration of robotics make spine surgery a promising field for the deployment of AI-based imaging technologies. Imaging-based AI projects show potential to enhance diagnostic and surgical efficiency, facilitate trainee learning and improve operative outcomes.

Keywords: Artificial intelligence; Imaging; Oncology; Robotics; Spine surgery; Surgical navigation.

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Conflict of interest statement

Declarations. Ethical Approval: This study was determined to be IRB exempt. Informed Consent: Not applicable. Competing Interests: Wellington Hsu is a paid consultant for Asahi, Medtronic Sofamor Danek, and Stryker. He has stock or stock options in Amphix Bio, and is a board or committee member for the Cervical Spine Research Society, Lumbar Spine Research Society and North American Spine Society. All other authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
(A) Navigation technology is used to optimize the incision placement for minimally invasive spine surgery. (B, C, D and E) Steps of the guided pedicle placement procedure are visualized along with corresponding imaging. (F and G) Illustrations showing the AI guided pedicle screw placement system and operative set up. Included with permission from the International Journal of Spine Surgery. All figures labeled for reuse according to Creative Commons Non-Commercial-No-Derivatives 4.0 [10]
Fig. 2
Fig. 2
Example of an augmented reality (AR) surgical navigation system. (A) AR headset (Microsoft HoloLens). (B) Surgical localization system (Northern Digital Inc.) which tracks surgical instruments in the operative field. (C and D) Example of calibration tools placed on operative instruments or at certain anatomical locations to orient the system. (E) Learners using AR technology to prepare for a spine surgery case. This technology can be used preoperatively or intraoperatively to better understand relevant anatomy, and surgical planning. Included with permission from Wolters Kluwer Health, Inc. All figures labeled for reuse according to Creative Commons Non-Commercial-No-Derivatives 4.0 [52]
Fig. 3
Fig. 3
(A) SonoVision display showing a nerve region (highlighted in yellow) located about 20 mm deep within the muscle. (B) Surgical dissection confirming the nerve identified in (A). Included with permission from Wolters Kluwer Health, Inc. All figures labeled for reuse according to Creative Commons Non-Commercial-No-Derivatives 4.0 [19]
Fig. 4
Fig. 4
Example of artificial intelligence guided computed tomography (CT) spine segmentation and analysis of lytic, blastic, and mixed lesions. All figures labeled for reuse according to Creative Commons Non-Commercial-No-Derivatives 4.0 [53]
See this image and copyright information in PMC

References

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    1. Patel NA, et al. Robot-assisted percutaneous pedicle screw placement accuracy compared with alternative guidance in lateral single-position surgery: a systematic review and meta-analysis. J Neurosurg Spine. 2023;39(4):443–51. - PubMed
    1. Fatima N, et al. Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis. Spine J. 2021;21(2):181–92. - PubMed

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