Autonomous Frameless Spine Registration and Robot-Assisted Surgery

Amit Kumar; T. A. Dwarakanath; Gaurav Bhutani; Dwarakanath Srinivas; Aliasgar Moiyadi

doi:10.1111/os.70342

Orthopaedic Surgery ›› 2026, Vol. 18 ›› Issue (7) :1471 -1490. DOI: 10.1111/os.70342

RESEARCH ARTICLE

Autonomous Frameless Spine Registration and Robot-Assisted Surgery

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Abstract

Objective: Accurate and efficient patient registration remains a critical challenge in robot-assisted spine surgery, where current methods often rely on invasive bone-mounted frames or intraoperative imaging that increases radiation exposure and procedural complexity.

Method: This article presents a novel non-invasive and contactless spine registration system that integrates a skin-affixed, radiopaque floating-point mask with a robot-mounted monocular camera. The system was evaluated in phantom experiments to quantify registration accuracy and pedicle-screw-axis targeting performance. The system autonomously establishes the pose of the pedicle-screw axis relative to the mask (patient) and surgical robot coordinate systems. A monocular camera mounted on the robot captures live images of the mask in the operating theater, enabling real-time visual recognition and tracking of the mask's elements. Advanced segmentation and pose estimation algorithms compute the spatial relationship between the vertebrae and the mask, accounting for accurate angular displacement between preoperative imaging and intraoperative patient posturing (CT-to-OT shift).

Results: Experimental validation on anatomically curved spine phantoms demonstrates millimeter accuracy in pedicle-screw path localization. The system facilitates accounting for changes in patient configuration from CT scan posture to OT surgical posture to provide an objective and accurate reference for image-guided pedicle screw placement. It eliminates intraoperative imaging while relying on preoperative CT and the registration was completed in under 4 min per vertebra.

Conclusion: The proposed system facilitates accounting for changes in patient configuration from CT scanner posture to OT surgical posture to provide an objective and accurate reference for image-guided screw placement, achieving registration within 4 min per vertebra. The invention facilitates frame-free patient registration both in manual and robotic spine surgery. The work lays the foundation for clinical translation through future cadaveric and pilot studies. All results reported in this study are limited to controlled laboratory and phantom conditions. Clinical performance and intraoperative feasibility remain to be established in future patient studies.

Keywords

autonomous spine registration / computer vision in surgery / floating-point mask / minimally invasive spine navigation / non-invasive patient registration / pedicle-screw placement surgery

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Amit Kumar, T. A. Dwarakanath, Gaurav Bhutani, Dwarakanath Srinivas, Aliasgar Moiyadi. Autonomous Frameless Spine Registration and Robot-Assisted Surgery. Orthopaedic Surgery, 2026, 18 (7) : 1471-1490 DOI:10.1111/os.70342

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