Most spine surgery uses off-the-shelf implants sized from a catalog, positioned based on experience and intraoperative judgment. For straightforward cases in normal anatomy, this works well. For patients with scoliosis, kyphosis, spinal deformity, complex revision surgery, or anatomy that falls well outside standard dimensions, standard approaches have real limitations — and a fully individualized surgical plan, from imaging through implant selection through intraoperative verification, changes the outcome potential in a meaningful way.
This page describes what a comprehensively individualized approach to complex spine surgery looks like in practice — one that integrates robotic preoperative planning, custom rods, patient-specific interbody cages, and intraoperative CT verification as a unified system rather than as isolated technologies used selectively.
Who This Is For
This level of individualization is used primarily for:
- Spinal deformity where the curve pattern, vertebral rotation, or sagittal malalignment creates anatomy that standard implants are not designed to address
- Revision spine surgery with significantly altered anatomy from prior procedures, where the original tissue planes and landmarks have changed and standard planning assumptions no longer apply
- Harrington rod revision and long-segment reconstruction, where decades-old instrumentation must be removed and an entirely new construct planned around the anatomy that remains
- High-grade spondylolisthesis and complex lumbosacral deformity, where the geometry of the slipped segment creates severe challenges for standard implant placement
- Any case where the preoperative plan determines that standard implants will not achieve the alignment goals or fit the anatomy safely
The Four Components of a Fully Individualized Plan
1. Robotic Preoperative Planning
Every case using robotic navigation begins with a detailed preoperative planning session on the patient’s own CT-based anatomy. A 3D model of the patient’s spine is constructed, and the planned trajectory, size, and depth of each pedicle screw is determined in advance — accounting for the patient’s specific bone dimensions, sclerosis patterns, and the deformity correction goals.
The Robot is used for most instrumented procedures. This means that before the patient reaches the operating room, every screw position has been planned against their actual anatomy, not against an average or a template. The plan is then executed intraoperatively with robotic guidance, reducing the reliance on intraoperative estimation for a step that is critical to both safety and biomechanical outcome.
2. Custom Rods
Standard spinal rods come in fixed diameters and are manually contoured in the operating room based on the surgeon’s experience and the emerging correction. For scoliosis or spinal deformities where the planned correction involves very specific sagittal and coronal targets, custom-contoured rods — manufactured to the preoperative plan before surgery — allow the implanted construct to match the intended alignment more precisely than manual intraoperative bending can reliably achieve.
Custom rods are produced from the same preoperative planning data used for screw placement, meaning the entire posterior construct is designed as a matched system for that patient’s anatomy and correction goals, not assembled from standardized components adapted in the moment.
3. Patient-Specific Interbody Cages
Interbody cages — the implants placed between vertebral bodies to restore disc height, achieve interbody fusion, and contribute to sagittal alignment correction — are typically selected from a set of standard sizes and angles. Standard cages work well in routine cases. In complex deformity, the endplate geometry, the specific lordosis angle needed at each level, and the anterior column height required may be outside the range that standard catalog options can match.
Patient-specific interbody cages are manufactured from titanium to match the exact endplate morphology of each patient’s disc space, sized to the planned interbody height, and angled to contribute the intended degree of segmental lordosis correction at each level. The cage footprint and end-plate contact are optimized for that patient’s specific anatomy rather than approximated from the nearest available standard size.
Dr. Sardar has been among the highest-volume surgeons in the world for patient-specific interbody cage implantation, a technology that is still early in adoption outside academic medical centers.
4. Intraoperative CT Verification
Once implants are placed, an intraoperative CT scan (using the O-arm system) confirms that every screw and cage is in the planned position before the wound is closed. This intraoperative verification — not a post-operative X-ray days later — allows any malpositioned implant to be identified and corrected while the patient is still on the table.
In combination with preoperative robotic planning, intraoperative CT essentially closes the loop between the surgical plan and the surgical result: the plan is executed with robotic precision, and the outcome is confirmed with CT-level imaging before the patient wakes up. This is the standard of care for all instrumented procedures in this practice.
Why This Matters
The value of individualized planning scales with the complexity of the case. In a patient with moderate single-level disease and normal anatomy, standard implants and intraoperative judgment are sufficient. In a patient with severe deformity, revision anatomy, or osteoporotic bone, the margin for deviation between the plan and the outcome is much smaller — and the consequences of a missed alignment target or a malpositioned screw are greater.
Individualized planning does not eliminate risk, and no technology substitutes for surgical experience and judgment. What it does is give experienced surgical judgment a more precise foundation to work from: the right implant for the right anatomy, placed according to a plan that was designed specifically for that patient, confirmed intraoperatively before the case ends.
Frequently Asked Questions
Does everyone who has surgery with Dr. Sardar get custom implants?
Robotic planning and intraoperative CT verification are used as standard for most multilevel instrumented procedures. Custom rods and patient-specific cages are used in scoliosis and complex deformity and revision cases where the anatomy or correction goals indicate that standard implants may not be optimal.
How long does manufacturing the custom implants take?
Manufacturing timelines vary by implant type, but elective surgery is scheduled to allow adequate lead time for the implants to be designed and produced from the preoperative CT data before the planned procedure date.
What imaging is needed for individualized planning?
A CT scan is required for 3D anatomical modeling. Full-length standing X-rays and MRI are also standard components of the preoperative evaluation for deformity planning.
Will insurance cover custom implants?
Most insurance plans cover custom implants used in medically indicated spine surgery. Coverage is typically based on the procedure performed and medical necessity, not on whether the implant is custom or standard. This is discussed individually during surgical planning.
How does this approach differ from what most spine surgeons do?
Most spine centers use robotic navigation, and someuse patient-specific cages in selected cases. The full integration of robotic preoperative planning, custom rods, patient-specific interbody cages, and intraoperative CT verification as a unified system for every appropriate complex case is very unique to Dr. Sardar’s practice.
About Dr. Zeeshan Sardar
Dr. Sardar is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University and uses individualized surgical planning including robotic navigation, custom rods, and patient-specific implants as standard for appropriate complex cases. To schedule a consultation or second opinion, call 212-932-5187 or visit the contact page.
This page is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition.
Reviewed by Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C — Last reviewed: July 2026.