Introduction: Preoperative and postoperative sagittal plane assessment is crucial in both spinal deformity and degenerative pathologies. Sagittal malalignment is a well-established cause of poor patient-reported outcomes. The currently available spine measurement software programs require users to identify several landmarks prior to calculating parameters, making them time-consuming and more reliant upon user experience. There is a growing need for an automated analysis tool that measures pelvic parameters with speed, precision, and reproducibility without relying on user-identified landmarks. A new AI algorithm has been developed to measure important radiographic parameters independently.
Aims/Objectives: Aim 1.) To evaluate and demonstrate that an algorithm based on artificial intelligence (AI) can independently determine spinopelvic parameters.
Hypothesis: The novel, fully automatic method will have a high agreement with human measurements for lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS).
Methods: From a total of 200 lateral lumbar radiographs (preoperative and postoperative images from 100 patients undergoing fusion) five independent observers (4 spinal surgeons, 1 senior researcher) digitally measured LL, PI, PT, and SS. Their parameters were compared with AI algorithm-generated parameters. Mean error (95% confidence interval, standard deviation) and inter-rater reliability were assessed using two-way mixed, single-measure intraclass correlation (ICC). ICC values larger than 0.75 were considered excellent (Ciccetti, Psychol. Assess. 1994).
Results: The novel algorithm’s spinopelvic parameter ICC values were excellent in 98% of preoperative and in 95% of postoperative radiographs (PreOp range: 0.85–0.92, PostOp range: 0.81–0.87). Exemplarily, mean errors are smallest for the PI (PreOp: -0.5° (95%-CI: -1.5°–0.6°; Fig. 1); PostOp: 0.0° (-1.1°–1.2°)) and largest for LL (1.3° (0.3°–2.4°); 3.8° (2.5°–5.0°)).
Conclusion: Novel AI algorithm automated spinopelvic parameter measurements from spine radiographs have a high degree of accuracy comparable to digital measurements by experts. This algorithm can improve physician workflow efficiency and reduce inter-rater and intra-rater measurement errors.
Colin Haines, MD – Virginia Spine Institute
Lindsay Orosz, MS, PA-C – The National Spine Health Foundation
Alexandra E. Thomson, MD, MPH – Virginia Spine Institute
Thomas C. Schuler, MD – Virginia Spine Institute
Christopher R. Good, MD – Virginia Spine Institute
Priyanka Grover, MS – RAYLYTIC GmbH
Marcel Dreischarf, PhD – RAYLYTIC GmbH
Rita Roy, MD – The National Spine Health Foundation
Ehsan Jazini, MD – Virginia Spine Institute
Dr. Colin Haines is a board certified spine surgeon and the Director of Research at Virginia Spine Institute. Dr. Haines performed the world’s first combined endoscopic and robot-guided spine surgery. His patient success has earned him a national feature on The Today Show and WebMD, and Top Doctor recognition in consecutive years.. Learn more about Dr. Haines.
Dr. Christopher Good is a double board certified spine surgeon and the President of Virginia Spine Institute. Established as a world expert in the field, Dr. Good has pioneered the use of robotics, navigation, and augmented reality (AR) in spine surgery. He performed the first two-level disc replacement in Metro DC, Maryland, and Virginia region, and continues to evolve motion-enhancing procedures for patients suffering from neck and back conditions. Dr. Good has been named “Top Doctor” consistently over the past decade. Learn more about Dr. Christopher Good.
Dr. Ehsan Jazini is a board certified spine surgeon at Virginia Spine Institute. He has been the first in the nation, and in the world, to perform advanced surgical techniques in cervical disc replacement, augmented reality (AR) spine surgery, and robotic spine surgery. Dr. Jazini was the first in the world to perform Augmented Reality guided personalized spine implant surgery using artificial intelligence. As a leading published author in the field of spine surgery, Dr. Jazini was selected as the Editor in Chief of The Spine Health Journal for the National Spine Health Foundation. Learn more about Dr. Jazini.
Reviewed by: Dr. Colin Haines, MD.