10101627Trueview system for safer spinal surgeryClosedCollaborative R&DInnovate UKSpinal degenerative disease is a common cause of chronic pain and workdays lost in the United Kingdom. The ageing population means that its prevalence continues to increase. Its estimated annual cost to the United Kingdom economy is over £10 billion. Scoliosis is another chronic and progressive spinal condition affecting children and adolescents. It is a common cause of severe pain and can severely limit educational attainment through lost school days. Vertebral fractures can result from traumatic causes that render the vertebral column unstable. Trauma is the leading cause of vertebral fracture in young people. Low-trauma vertebral fractures are mainly seen in elderly people as a typical type of osteoporotic fractures. Studies have shown that these injuries are common, with the number of vertebral fractures increasing by 45.6% between 2009 and 2019, an incidence of 150.7 per 100,000 inhabitants. \[Dong, 2022\] Spinal fusion surgery is a common management strategy for all these conditions. It involves the implantation of multiple screws and rods into the spine, to reduce pain, correct deformity and facilitate return to work. The most severe complication of this surgery is spinal cord injury and paralysis caused by inaccurate screw insertion into the pedicle; a narrow bridge of bone in the vertebra. Screw misplacement occurs in 10% of cases and can also be associated with significant blood loss. 5% of cases require revision surgery to replace/remove a screw. Despite the severity of these complications, diagnosis of a misaligned screw is challenging with modern imaging technologies and often, problems are not identified until days or weeks after surgery. This leads to long standing pain, disability and in severe cases, paralysis for patients. Resources may need to be allocated away from new patients and towards providing revision surgery and aftercare in patients where screws were initially misplaced. Direct costs of screw revision surgery exceed £18 million annually in the UK and the NHS spends £36 million on litigation resulting from misplaced pedicle screws causing nerve and spinal cord injury \[GIRFT, 2019\]. Trueview is developing a device for intraoperative use to diagnose and prevent potential spinal cord injury. The project aims to improve the safety of spinal surgery by preventing the misalignment of pedicle screws. This will prevent patient harm, reduce re-operation rates and the cost of revision surgery to healthcare providers, while minimising the economic burden of work and school days lost to the economy.