Implementation of artificial intelligence (AI) in ASD treatment

Abstract

Background: Adult spinal deformity (ASD) surgery remains one of the most complex and complication-prone areas of spine care, with significant variability in outcomes and high complication rates. Recent advances in artificial intelligence (AI) have shown to be promising tools to address these challenges by improving planning, prediction, and personalization. This narrative review explores the role of AI across the surgical workflow for ASD, from preoperative decision-making to intraoperative execution and postoperative care. Methods: We conducted a comprehensive narrative review of current literature and technologies related to AI in ASD surgery. Focus areas included evidence synthesis, predictive analytics, automated radiographic assessment, intraoperative navigation, patient-specific implants, and digital patient engagement. We also present a representative case example of AI-assisted deformity correction to illustrate practical clinical application. Results: AI tools have demonstrated strong potential in improving accuracy and efficiency across various domains. Machine learning algorithms outperform traditional statistical models in predicting complications, length of stay, and functional outcomes. Automated radiographic platforms reliably reproduce spinal alignment measurements and support surgical planning. Personalized instrumentation has been associated with improved alignment fidelity. Lastly, Intraoperative AR/VR platforms and AI-enhanced robotics are helping to standardize execution and reduce variability. Conclusions: AI is redefining the landscape of ASD surgery through its ability to enhance decision-making, reduce variability, and enable personalized, data-driven care. While widespread adoption requires ongoing validation and integration, current evidence supports the clinical utility of AI-assisted strategies in improving alignment outcomes and surgical safety. This review highlights the growing potential of AI to serve as a cornerstone of precision spine surgery.