The Science Behind SDI
Every biomarker in the SDI Platform is backed by peer-reviewed research. Led by our founding team at Hospital for Special Surgery, our work has produced 236+ publications demonstrating that soft tissue health predicts surgical outcomes.
Investigating the intelligence surgeons need before they enter the operating room
Our research asked a different question
Can we extract quantitative biological information from standard imaging?
Can we measure tissue quality, not just anatomy?
The answer is yes.
And that discovery forms the foundation of Surgeon Decision Intelligence.
Our Discovery Journey
Spine-Specific Sarcopenia (SSS)
Finding
Preoperative atrophy of the posterior paraspinal muscle is associated with a future adjacentsegment disease (ASD) revision surgery, with fatty infiltration of themultifidus being the key imaging predictor.
Clinical Impact
Assessment of not only bone, disc, and neural structures, but also of the surrounding muscular envelope on MRI, may be key for improved patient counseling and surgical decision-making.
Abdominal Aortic Calcification (AAC)
Finding
AAC is independently associated with posterolateral fusion impairment following spinal fusion surgery
Clinical Impact
Routine preoperative assessment of AAC on lateral spine radiographs may help identify patients at higher risk for impaired fusion and guide surgical decision-making
Advanced Glycation End-Products (AGEs)
Finding
AGE accumulation significantly higher in degenerated discs
Clinical Impact
AGEs associate with matrix degradation and degeneration phenotype
Modic Changes (Type 1, 2, 3)
Finding
Endplate signal changes on MRI predict long-term outcomes — Modic Type 2 associated with poor 10-year results.
Clinical Impact
Guides patient selection and informed consent discussions.
Disc signal intensity index (DSI2)
Finding
Age and congestive heart failure are independent risk factors for degenerative progression using DSI2 in a lumbar longitudinal dataset.
Clinical Impact
It supports longitudinal risk-factor discovery that can matter for perioperative planning.
Vacuum Disc Phenomenon
Finding
The presence of IVP in degenerative disc disease is a sign of segmental instability
Clinical Impact
This is important for planning spinal fusion surgery
Facet Effusion
Finding
In degenerative spondylolisthesis, facet joint fluid on MRI is linked to dynamic instability
Clinical Impact
The presence of facet fluid and dynamic instability may predict increased likelihood of achieving MCID for improvement in back pain following posterior lumbar fusion
For Researchers
The SDI Platform makes it possible to capture quantitative soft tissue biomarkers quickly, consistently, and at scale from standard clinical imaging. What once required time-intensive manual review can now be measured across large datasets, opening the door to broader and more efficient research.
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For researchers, this creates a powerful opportunity: to study soft tissue health across institutions, populations, and timepoints with greater consistency. By making biomarker collection easier and more scalable, the platform can help accelerate discoveries in degeneration, surgical risk, recovery, and long-term outcomes.
As adoption grows, SDI has the potential to support a global research ecosystem — enabling investigators to better understand how soft tissue biology influences spine care and musculoskeletal health overall.
A new way to study soft tissue biology at scale.
Scalable biomarker collection from routine imaging
Consistent measurement across large patient populations
Useful for retrospective, prospective, and multicenter research
Designed to expand understanding of soft tissue health and outcomes
Interested in Collaborating?
Learn how SDI can support your research initiatives and multicenter studies.