Predictive Model/ Analyzer Simulation
"Does my data go into feeding the predictive model?"
Past UNiD post-op data was used to create the AI predictive model. The current models are static due to FDA regulations, meaning that as more post-ops are measured, they do not automatically feed back into the model. However, you will have access to all your post-op data and analytics to see how the outcomes compare to the planned alignment.
"Can you approve the case for me?"
While I can assist with planning and walk you through the case details, the actual approval must come from you as the surgeon. This is a quality and compliance requirement to ensure that the final plan reflects your surgical intent and preferences.
"Do you plan in the coronal plane?"
While we don't not currently plan any simulations on the coronal image, we still mark up major landmarks and endplates up to T1 to determine coronal cobb angles & coronal balance. We then will assess any preoperative coronal curves within the intended fusion levels & coronally lengthen the rod appropriately to ensure it is long enough once the patient is corrected in the coronal plane. We can also provide differential contouring between the rods if you would like to use that as a method of de-rotation for large coronal curves.
"Why is my screw mark at S1 if I am going to the pelvis?"
We are able to more accurately predict the S1 screw trajectory, so we place the most caudal screw marking at S1 but extend the rod enough caudally past the S1 screw to account for pelvic fixation.
What is the value for surgeons who do not find the rod beneficial?
Single sentence overview: UNiD supports planning precision, alignment goals, and postoperative insights.
Specifics: segmental planning to visualize and simulate correction at each level, only FDA-approved predictive model in sagittal alignment, post-operative analytics, etc.
The surgeon has a high-grade spondy and mentions they use Mazor 5.1. How would you address?
One of the limitations with using Mazor and UNiD is that we are not able to simulate spondy correction. If the plan includes a high-grade spondy, we can simulate correction; however, the Mazor file will not be available. Alternatively, we can chose not to reduce the spondy but still draw the rod assuming the spondy has been corrected so that the Mazor file generates. Do you plan to use the UNiD Mazor file for this case?
"What do you think? Which plan looks better?"
Sample talk track to redirect the focus back to the surgeon: Which alignment goals are you prioritizing for this case? Plan A optimizes X (ex. PI-LL mismatch), whereas Plan B focuses on Y (ex. keeping the SVA positive).
"Do you bend rods in the coronal plane?"
Currently we are only bending rods in the sagittal plane; however, we do lengthen the rod to account for coronal correction.
"Can you plan on MRI or CT? This patient doesn't have an x-ray."
We can plan using MRI or CT images; however, these typically do not include the femoral heads, which affects the foundational PI measurement. There may also be discrepancies between supine and standing alignment. Our predictive model is unfortunately not applicable on supine imaging. As long as you’re aware of these limitations, we’re happy to proceed.
"Are UNiD Titanium rods pure Titanium? My patient has a Nickel allergy."
No, our Ti rods are a titanium alloy. I can send you the breakdowns if you'd like.
Our CoCr rods do have nickel in them, but Ti alloy is nickel free.
*sees interbody planned at 10 deg* "I can't get 10 deg of correction." How would you address?
The angle displayed on the UNiD plan represents the implant lordosis, not the amount of correction. The amount of correction is dependent on the preoperative disc angle, and we can display this in text on the plan if you are interested.
"A surgeon I practice with doesn't have to approve their cases, can I get that too?"
"Can I have my rep or PA approve?"
We do offer a Surgeon-Driven Engineer Approval option for surgeons who have done at least 20 cases with us, which allows you to give permission to your engineer to approve specific case types for you. If you are interested in this option, we can explore it further down the line.
We're only allowed to have other surgeons approve cases, not reps or PAs.
"I like to over and under bend my rods before implanting. Can you guys do that on your rods?"
Yes absolutely, we can differentially contour the rods. How much would you like the rods over/under bent? Typically surgeons start with +/- 5-10 deg. We can contour both the thoracic and lumbar regions.
"How does the UNiD rod design account for previously instrumented levels?"
If prior instrumentation is present, we will assume the patient is fused and that the disc is immobile unless explicitly stated otherwise.
In these cases, we standardly design the new rods to overlap with the existing hardware. If there is an offset on the lateral view, we typically split the difference to avoid significant disparities between the rods. While alignment should be fairly close, complex revision cases may still require in situ adjustments.
"I use capped rods. Can I order UNiD rods?"
Unfortunately at this this time, we do not offer capped rods.
"I am doing a PCO at every level but I only see 2 on the plan. Why aren't we simulating those?"
The simulated PCOs in our plan represent sagittal correction needed at that segment, but it is understood that you may perform PCOs at every level to loosen up the spine and/or improve coronal correction.
"Can I do an email or text approval?"
We standardly require all approvals to go through the Hub, either via the Desktop version or a mobile app; however, if you are experiencing technical difficulties, we can explore other options on a case-by-case basis.
The surgeon doesn't want the hex on the standard rod. How would you address?
Unfortunately, our raw rod stock already includes the hex. What we can do is relocate the hex to the cranial end instead of the default caudal end, change the rod to dual diameter or MIS which only has the soft bullet head, or can add an additional rod level on the hex end that can be cut intraoperatively.
"Can you tell me which levels I need to fuse or which levels needs cages?"
While we cannot tell you which levels to fuse or where to implant cages, we can provide multiple plans so that you may compare them and chose which plan better achieves your alignment goals.
"Does UNiD support trauma cases? We get imaging 2 days before surgery."
Unfortunately, we need at least 3 days before DOS to be able to manufacture rods. Alternatively, we can produce a digital plan and track postoperative results for a planning fee.
"My cage height looks unreasonable for the disc. Can we adjust the cage height on this plan?"
X-rays are a 2D representation of a 3D deformity, so we are only able to estimate the disc height and volume. Since we cannot account for intraoperative technique (such as disc preparation or inseration method), the provided cage heights should only serve as a starting point. As long as the implant lordosis aligns with the UNiD plan, any variation in cage height will have minimal impact on achieving the alignment.
"How soon can I get rods if I approve now?"
We ask for the plans to be approved 7-10 days before the DOS to insure delivery on-time. However, our rods are manufactured in order of DOS, so the exact shipping timeline may very depending on where the case is in the manufacturing queue.
"Can I get a line going up and down the entire rod?"
"Can I get screw marks at every level?"
Unfortunately, the sagittal marker cannot be manufactured along the entire length of the rod because it would compromise the rod’s structural integrity. Instead, for standard rods, we can provide a 25 mm sagittal marker at the cranial end in addition to the default caudal marker.
Unfortunately, UNiD rods have the option to have a maximum of 2 screw marks at any level etched into the rod to not compromise the rod's structural integrity.
"Can you predict PJK?"
While we cannot predict PJK, we can provide the PJA measurements on your plans. Additionally for Adult Deformity plans where we predict TK relaxation above the construct, if the planned TK is concerning to you, we can make changes to the plan.
"Can I order two different alignment plans (ex. cages vs. PSO)?"
Unfortunately, our system is not designed to produce two different alignment plans; however, we can send you multiple sets of rods with different contours/levels on the same alignment plan.