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At a recent session hosted by the Seattle Spine Foundation, Dr. Sigurd Berven discussed a challenge central to every spine deformity surgeon’s practice: achieving alignment that precisely matches preoperative goals.
Today, we have more information regarding intraoperative alignment goals and more patient specific information regarding appropriate alignment than we have ever had in the past. The accurate assessment of intraoperative alignment though still depends on fluoroscopy or low-dose CT performed intermittently during the procedure. Those images capture moments, not motion, and are not responsive to ongoing changes during the procedure. Between scans, the alignment of the spine continues to change with maneuvers including distraction, compression, rod contouring, and osteotomy correction, leaving a gap between intended and achieved alignment.
As Dr. Berven summarized, “We know quite precisely about what our goals and expectations for alignment are, but our observed alignment outcomes oftentimes don’t match those goals.”
The relationship between spinal alignment and patient outcomes is well established. Sagittal vertical axis (SVA), pelvic incidence–lumbar lordosis (PI–LL) mismatch, and segmental lordosis distribution correlate strongly with function and revision rates. Yet intraoperatively, surgeons often rely on visual estimation or static imaging at times that may not be amenable to intraoperative changes to confirm these parameters after fixation.
Dr. Berven noted “[my] threshold for making a change after I put in my instrumentation is a little bit higher than it would be if I could in real time, continually, without radiation, find out what my alignment is.”
Real-time intraoperative measurement addresses that limitation. On-demand visualization of sagittal and coronal alignment enables the surgical team to quantify changes in thoracic kyphosis, lumbar lordosis, and overall balance as they occur, not after closure. Small adjustments to rod contour, compression, or translation can be made before final tightening, improving fidelity to the surgical plan.
From Static to Dynamic Feedback
In his demonstration, Dr. Berven showed how optical and infrared imaging can capture surface and depth data to map alignment continuously without radiation. Real-time measurement revealed in seconds how corrective maneuvers altered curvature and coronal balance, eliminating workflow interruptions and the need to re-image the field.
For the operating team, this dynamic feedback loop offers several potential advantages:
By converting what was once qualitative judgment into quantitative data, surgeons can gain an on-demand, three-dimensional view of alignment evolution, an especially meaningful advance in complex deformity and revision cases.
Real-time alignment data may eventually bridge the gap between what happens in the operating room and how patients function afterward. Continuous measurement creates a record that can be correlated with postoperative imaging and PROMs, offering new ways to study how intraoperative precision affects revision rates, rod fracture, or proximal junctional failure.
Dr. Berven emphasized that by “using AI-guided techniques, we may apply advanced analytics to learn about optimal workflow, equipment utilization, and variations between surgeons that would lend value to even the most experienced surgeons. Such analysis could illuminate subtle technique variations that influence and optimize efficiency, blood loss, and utilization of equipment.
The Seattle Spine Foundation continues to play a pivotal role in advancing surgical education. By convening surgeons, researchers, and technologists in live demonstrations like Dr. Berven’s, SSF fosters the open exchange of data and experience that drives the field forward.
These sessions highlight not just new technologies but a broader evolution in surgical thinking. In this case: from static verification to continuous measurement, from isolated expertise to collective learning.
Dr. Berven will return to the Seattle Spine Foundation in the coming weeks to continue this discussion and share new insights into real-time intraoperative measurement.
For those who couldn’t attend in person, SSF’s YouTube channel offers full recordings of this session, including Dr. Berven’s demonstration, along with many other presentations from leaders in spine surgery. It’s an outstanding educational resource for anyone interested in alignment, precision, and surgical innovation.
👉 Visit the Seattle Spine Foundation YouTube channel to explore these sessions and stay up to date on future talks (Note: The videos include footage from a surgical cadaver lab intended for educational purposes.)
As real-time intraoperative measurement becomes more integrated into deformity correction, surgeons may gain an unprecedented ability to close the loop between planning, execution, and outcome.
On-demand, radiation-free feedback provides the quantitative visibility needed to achieve alignment targets with greater confidence, and to document precisely how those results were achieved.
For the spine community, that means turning every procedure into a source of data, learning, and refinement, a step closer to the enduring goal of predictable, reproducible precision.
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