AIBLE™ SMART ECOSYSTEM
The AI behind AiBLE™
AI enables predictive planning, automated workflows, and low-dose intraoperative imaging for spine and cranial procedures
How does AI power the AiBLE™ ecosystem?
Behind the technologies within the AiBLE™ smart ecosystem is a powerful engine — artificial intelligence — helping support a more connected, informed, and efficient surgical experience.
AI works across connected AiBLE™ technologies to:
- Generate patient-specific surgical plan options
- Automate time-intensive processes like segmentation and tractography
- Enable real-time intraoperative insight
- Reduce radiation dose while maintaining image quality
Together, these capabilities support a more data-driven, personalized approach to spine and cranial care.
How is artificial intelligence used in spine surgery?
GAiTEWAY™ platform: AI for predictive spine planning
The GAiTEWAY™ platform uses artificial intelligence models to support pre-operative spine planning. These models generate multiple surgical scenarios based on surgeon goals and treatment strategy.
Trained on data from more than 50,000 longitudinal patient records and patient-specific inputs, including age, height, weight, and sex, AI predicts post-operative alignment outcomes.
By forecasting compensatory changes in unfused spinal segments, GAiTEWAY™ helps surgeons evaluate potential long-term outcomes and select an appropriate surgical approach.
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| Peds 2.0 | Adults 2.0 | Degen 2.0 | |
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At 6 months post-op:
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At 12 months post-op:
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Spine segmentation
The Stealth AXiS™ system applies deep learning–based AI to automatically segment vertebrae from CT imaging. This replaces manual workflows, helping reduce planning time and improve efficiency.
This AI-driven segmentation supports advanced planning, including automated screw trajectory, interbody and facet decortication planning, alignment optimization, and integration with GAiTEWAY™ plans.
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| Intraoperatively, AI enables real-time visualization with LiveAlign™ segmental tracking, allowing surgeons to monitor vertebral motion and alignment during procedures. | |
Cranial automatic tractography
For cranial procedures, AI automates tractography using probabilistic CSD models to generate patient-specific fiber maps without manual input.
This provides immediate visualization of key neural pathways, including motor, language, visual, and sensory tracts, to support personalized planning and surgical pathway evaluation.
 Motor: Cortico spinal tract (CST) |
 Vision: Optic radiations (OR) with Meyer's loop |
 Language: Arcuate Fasciculus (AF) |
 Sensory: Medial Lemniscus (ML) |
 DBS target VIM: Decussating Dentato-Rubro-Thalamic tract (dDRT) |
O-arm™ imaging system: AI for low-dose imaging
Spine Smart Dose
The O-arm™ imaging system offers spine smart dose, a lower-dose imaging protocol that uses AI-based image reconstruction to maintain image quality during intraoperative imaging.
Spine Smart Dose reduces the number of x-ray projections compared to a standard dose from approximately 391 to 100 projections, significantly lowering radiation exposure. Acquiring fewer projections may increase image noise, which can degrade image quality. Spine Smart Dose applies machine learning during image reconstruction to reduce noise and artifacts, restoring image quality and producing a clear and clinically useful image for confident navigation.
This approach results in approximately 70% less dose compared to standard mode and 35% less compared to low-dose mode imaging protocols.
 Standard dose 391 projections |
 Sparse (100) projections |
 Spine smart dose Sparse (100) projections |
What this means for surgical workflows
Across the AiBLE™ ecosystem, artificial intelligence supports:
- More informed pre-operative planning
- Reduced manual and time-intensive workflows
- Real-time intraoperative visibility
- Lower radiation exposure during imaging
These capabilities work together to enable a more connected, data-driven surgical experience.
AI supports both pre-operative planning and intraoperative workflows. Before surgery, AI enables predictive planning, automated segmentation, and patient-specific tractography. During surgery, AI supports capabilities such as LiveAlign™ segmental tracking to provide real-time visualization and AI-enhanced image reconstruction and lower-dose intraoperative imaging.
Types include predictive AI models for surgical planning, deep learning for automated image segmentation, probabilistic models for cranial tractography, and AI-assisted image reconstruction to maintain image quality while reducing radiation dose.
Artificial intelligence within the AiBLE™ smart ecosystem is designed to support—not replace—clinical decision making. AI helps automate repetitive tasks, generate patient-specific insights, and enhance visualization so surgeons can make informed decisions using their clinical expertise and experience.
AiBLE™ is the first fully integrated ecosystem that closes the loop across the surgical journey. From AI-driven pre-op planning to robotics, navigation, imaging, and post-op insights, AiBLE™ transforms intention into predictable outcomes. AI supports surgeons throughout the surgical workflow, from pre-operative planning through intraoperative imaging and navigation — to improve efficiency and enable more personalized surgical care.
* Siemens Healthineers AG is the legal manufacturer of the Multitom Rax
** ePRO is an offering of OBERD™*