Plan and record spinal instrumentation surgery

The most data-rich moment in a spinal case leaves the least durable record. Once the wound is closed, the detail of what was implanted, the maker, the system, the sizes, the levels and the UDI, is hard to recover. Surgeons end up squinting at old films, or posting a photo of a screw head to a forum to identify their own patient's implant.

Skeletal Plan is a deterministic, rule-based tool built by a spine surgeon. Every specification traces to GUDID or published manufacturer data. It works across major manufacturers, runs offline in any browser, supports 22 languages, and makes no clinical claims and no use of AI.

The workflow is three low-friction steps. Plan the construct before you operate. Capture it in theatre by scanning the UDI barcode, so the implant identifies itself. Keep a professional plan and record that lives on, ready for revision, research, billing and audit.

Plan the construct

Design the construct level by level: screws and trajectories, rods, interbody and reconstruction cages, plates, osteotomies and correction forces. Plan across normal or variant anatomy, on a single screen or a dual-window theatre display. Skeletal Plan marks the chosen osteotomy and records the intended correction. It does not measure the deformity or compute correction angles; use dedicated deformity-planning software for that.

Scan the implants

Record the implants you used. Scan the UDI barcode (GS1 DataMatrix, GS1-128 or HIBC) to auto-fill the system, size, lot and expiry, or enter sizes by hand when screws arrive on a non-sterile tray with no packaging to scan. A case scan pool collects everything used and lets you allocate it to levels.

Keep the record

Keep a clean, exportable record that stays useful long after the case: a PDF for the patient record, an implant inventory for stock and cost, lot and expiry traceability for audit, and structured data for research. Share it with a colleague through an anonymised link or QR code.

What This App Does

A digital documentation tool for spinal surgery instrumentation. Records the pre-operative plan and post-operative construct, replacing hand-drawn diagrams with a structured, exportable format.

Runs offline in any modern browser with no installation, no server, no network required. Available as a web app (plan.skeletalsurgery.com/spine) or standalone HTML file for USB/email distribution.

Exports to JPG, PDF (A4), and structured JSON for clinical records.

Key Features

• Polyaxial / monoaxial / uniplanar head types, 5 hook types, bands / wires / cables, with free-text annotations. Modular systems route catalogue-driven shank, head, and locking-hardware UDIs separately.
• Screw trajectory system: pedicle, lateral mass, pars, translaminar, transarticular, cortical (CBT) per level
• Screw shank visualisation: projected PA view with published convergence angles
• Multi-system implant support: up to 5 screw systems per case with per-placement system selection
• Population-based screw reference data with published source citations (opt-in via Preferences)
• Standard vs specialist sizes. Screw-size pickers default to the diameters listed on the manufacturer's Surgical Technique Guide (STG) ordering matrix. Sizes filed in regulatory UDI/GUDID registries but absent from the STG (half-mm specials, regional or custom-order SKUs) are classified specialist and don't appear by default. Specialist sizes still scan, still accept custom-typed values, and any specialist size already on a placement remains visible in the dropdown with a leading bullet (•). Toggle in Preferences › Implant.
• Modular screw systems: shank, head, and locking hardware as separate UDIs (e.g. Medtronic ModuLeX); cross-system rejection dialog warns when a scan does not match the active system.
• 6 surgical approaches (ACDF, PLIF, TLIF, XLIF / LLIF, OLIF, ALIF) filtered by anatomical level, drawn from a multi-manufacturer cage catalogue
• Reconstruction cages (vertebral body replacement): multi-level corpectomy span (up to 4 vertebrae), end-cap geometry, structured catalogue picker across major manufacturers (DePuy Synthes, Globus Medical, Medtronic, Stryker, VB Spine; coverage expanding) with manual entry for others
• Spinal plates: anterior cervical (max 5 levels), ALIF (max 3), lateral (max 2), and posterior occipital, with UDI scanning that auto-fills system, length, hole count, and locking-screw fixation
• Artificial discs: cervical ACDR (M6-C, prodisc C, Mobi-C, Bryan, Synergy) at C3-C7 and lumbar TDR (prodisc L, activL, Charité, M6-L, Maverick) at L3-S1 with FDA / CE regulatory status per device
• Posterior osteotomies (Schwab 1–6) and anterior corpectomy reached via a vertebral-body popover; VCR / ML-VCR carry a free-text reconstruction-cage note
• 13 decompression procedures (laminectomy, laminotomy, hemilaminectomy, laminoplasty, foraminotomy, skip laminectomy, transpedicular, costotransversectomy, partial / complete facetectomy, discectomy, flavectomy, undercutting) with Lee-zone detail and MRI-style axial diagram
• 6 biomechanical force vectors (translate left / right, compress, distract, derotate clockwise / anti-clockwise)
• 16 implant manufacturers, 97 screw systems with kit-aware size validation; tiered picker (top-5 vendors above, others alphabetical)
• Bone graft recording (Local Bone, Autograft, Allograft, Synthetics, DBM, BMP, multi-select) with free-text notes
• Structured rod data: material, diameter, profile, contour, length per side, with linked lengths to keep left / right matched
• Barcode scanning (UDI / GTIN / HIBC): camera, handheld scanner, or manual entry auto-fills system, size, lot, and expiry from a catalogue of over 90,000 GTINs spanning 130+ systems.
• Case scan pool: pre-scan implants before placement; the sidebar pool surfaces unrouted scans (including locking-screw and cage-anchor hardware) and auto-fills the next matching modal.
• Move-to-level: change a placement's anatomical level from inside its modal without losing scan or annotation data; cervical ↔ lumbar moves are blocked for plates, cages, and discs
• Record locking (Finalise Record): prevents accidental edits to finalised records
• Clear Construct button: reset the surgical record without affecting the plan
• Auto-generated implant inventory with summary totals, grouped by screw system, auto-shrunk to fit the export sheet
• 10 colour themes (5 corporate-branded + 4 dark + default)
• Export as JPG, PDF (A4, 400 DPI, with embedded clickable case link), or JSON (with UUID, audit timestamps, and barcode traceability)
• Encryption at rest: the cached case is automatically encrypted with a per-browser AES-GCM 256-bit key stored as non-extractable in IndexedDB. No user passphrase. Clearing site data deletes the key and the cache becomes unrecoverable.
• Share Link: a self-contained URL that encodes a PII-stripped copy of the case in the URL hash fragment (compressed, not encrypted; treat as an email attachment)
• Dual-window sync for theatre displays via BroadcastChannel: state, theme, language, view, and Privacy Mode all sync between windows
• Ghost placements: planned items appear as faint overlays on the Final Record column until tapped and confirmed

Basic Workflow

1. Enter patient details and choose implant supplier / screw system (multiple systems supported)
2. Choose the region view (Cervical, Thoracolumbar, Lumbar, or Whole Spine)
3. Select a tool from the palette (screws, hooks, cages, plates, decompression, etc.)
4. Click left or right of a vertebra to place a screw, hook, or sublaminar fixation
5. Click between vertebrae for an interbody cage, disc-level osteotomy (Facet, Ponte), spinal plate, or artificial disc
6. Click on the vertebral body (midline) and the popover offers Osteotomy (PSO, VCR, ML-VCR) or Corpectomy (body resection + reconstruction cage)
7. Pre-scan implants if available: UDI scans land in the Case Scan Pool and auto-fill the next matching modal
8. After surgery, switch to the Final Record column and confirm or adjust planned placements (planned items appear as ghosts)
9. Export as JPG, PDF (A4, with embedded case link), or save as JSON; lock with Finalise Record when complete

Dual-Window Mode

Open the app in two windows of the same browser on a computer with two or more screens. Changes sync automatically via BroadcastChannel: state, theme, language, view, and Privacy Mode all match across windows. A green link icon confirms the connection.

Tip: rotate the second monitor to portrait so the Plan and Final Record columns each get full vertical room.

Sharing & QR Codes

Typical uses: pre-briefing implant company reps so the right kit is staged for theatre, and discussing cases with colleagues for second opinion, multidisciplinary review, or teaching.

• Cases can be shared via QR code or URL link: both use the same compressed encoding
• Patient-identifying fields (name, date of birth, ID, sex, surgeon, date, location) are automatically removed before sharing
• Shared data is deflate-compressed and encoded in the URL hash fragment (never sent to a server), but it is not encrypted. Anyone with the link or the QR can decode it; treat it like an email attachment.
• If a case is too large to share, notes are removed first, then the plan, keeping only the final construct record
• If the case is still too large after stripping, sharing is unavailable: save as file instead
• For full case sharing with all data preserved, use Save as File (JSON)

File Format & Compatibility

Cases are saved as a structured JSON file. Older saved files are automatically upgraded when opened, and we maintain support for every released format and intend to continue doing so.

Most importantly, PDFs exported from any version embed a clickable case link, so a previously exported or filed PDF can always be reopened in the planner.

In the rare event an older record cannot be opened in the current version, a route to access it remains available.

Manufacturers

Skeletal Plan works across major spinal implant manufacturers. Specifications are traced to GUDID or published manufacturer data, so a scan or a manual entry reflects the real catalogue, not a guess.

Frequently asked questions