SpineForge Planner: Free and Open-Source Software for Spinal Alignment Analysis and Surgical Planning.

Area of Science:

• Spine surgery and biomechanics
• Medical imaging analysis
• Open-source software development

Background:

• Precise sagittal spinopelvic parameters are crucial for spine surgery outcomes.
• Commercial platforms like Surgimap are becoming inaccessible.
• Manual measurements are inefficient and prone to variability.

Purpose of the Study:

• Develop and validate SpineForge Planner, a free, open-source software for sagittal spinopelvic alignment analysis.
• Address the critical accessibility gap in spine surgery planning tools.
• Provide comprehensive surgical planning functionalities.

Main Methods:

• Developed in Python 3 with Digital Imaging and Communications in Medicine (DICOM) support.
• Included surgical planning modules: screw trajectory, rod contouring, and osteotomy simulation.
• Validated using 50 patients from a public dataset, comparing measurements against Surgimap.

Main Results:

• SpineForge Planner demonstrated good-to-excellent reliability (Intraclass Correlation Coefficients [ICC] ≥0.89) for 8 sagittal parameters compared to Surgimap.
• Sagittal Vertical Axis (SVA) measurements showed highest agreement (ICC = 0.999).
• Measurement times were comparable (SpineForge: 70.0s vs. Surgimap: 73.7s), with clinically negligible differences.

Conclusions:

• SpineForge Planner offers non-inferior measurement reliability to commercial platforms.
• It provides essential surgical planning tools within a free, open-source framework.
• The software enhances universal access to precise sagittal alignment assessment tools for improved surgical planning and outcomes.