Kinematic analysis of lumbar pedicle screw placement using an artificial intelligence framework.

Abstract

Objective: Robotics and artificial intelligence (AI) are being increasingly integrated in spine surgery. One emerging application of AI is in hand motion detection to assess surgical skill. However, no standardized framework currently exists for evaluating trainee proficiency in spine surgery. This proof-of-concept study applied AI-based motion analysis and the machine learning (ML) pipeline to evaluate hand movements during lumbar pedicle screw placement, aiming to generate objective metrics for skill assessment.

Methods: AI-based motion tracking was used to analyze hand movements during pedicle screw placement on a lumbar spine sawbone model. Video recordings of hand movements during freehand (FH) and robot-assisted (RB) pedicle screw placement were analyzed to extract metrics including distance, displacement, speed, velocity, acceleration, jerk, and normalized jerk index. Due to the limited number of participants, data augmentation techniques were used to generate synthetic data to expand the dataset. Extracted and derived kinematic metrics were then evaluated for their ability to predict training level and surgical technique.

Results: In general, procedure time and movement distance appeared to decrease with increasing trainee experience, with more pronounced improvements in FH procedures. Kinematic analysis trended toward a reduction in speed, displacement, and jerk variability across training years. RB procedures were associated with reduced movement variability as extremes in velocity, acceleration, and jerk were limited. ML models were able to classify augmented data by training level and procedure type with acceptable accuracy.

Conclusions: This proof-of-concept study presents a data processing pipeline capable of analyzing metrics to quantify surgical proficiency during spinal procedures. The methods described demonstrate the feasibility of using AI-driven video analysis to assess hand motion. It also highlights specific motion-based metrics that can distinguish between FH and RB techniques and correlate with surgical training level. These findings lay the groundwork for developing a standardized, objective framework for proficiency assessment in spine surgery.