Fully automated radiological analysis of spinal disorders and deformities: a deep learning approach

Fabio Galbusera, Frank Niemeyer, Hans Joachim Wilke, Tito Bassani, Gloria Casaroli, Carla Anania, Francesco Costa, Marco Brayda-Bruno, Luca Maria Sconfienza

Research output: Contribution to journalArticlepeer-review


Purpose: We present an automated method for extracting anatomical parameters from biplanar radiographs of the spine, which is able to deal with a wide scenario of conditions, including sagittal and coronal deformities, degenerative phenomena as well as images acquired with different fields of view. Methods: The location of 78 landmarks (end plate centers, hip joint centers, and margins of the S1 end plate) was extracted from three-dimensional reconstructions of 493 spines of patients suffering from various disorders, including adolescent idiopathic scoliosis, adult deformities, and spinal stenosis. A fully convolutional neural network featuring an additional differentiable spatial to numerical (DSNT) layer was trained to predict the location of each landmark. The values of some parameters (T4–T12 kyphosis, L1–L5 lordosis, Cobb angle of scoliosis, pelvic incidence, sacral slope, and pelvic tilt) were then calculated based on the landmarks’ locations. A quantitative comparison between the predicted parameters and the ground truth was performed on a set of 50 patients. Results: The spine shape predicted by the models was perceptually convincing in all cases. All predicted parameters were strongly correlated with the ground truth. However, the standard errors of the estimated parameters ranged from 2.7° (for the pelvic tilt) to 11.5° (for the L1–L5 lordosis). Conclusions: The proposed method is able to automatically determine the spine shape in biplanar radiographs and calculate anatomical and posture parameters in a wide scenario of clinical conditions with a very good visual performance, despite limitations highlighted by the statistical analysis of the results. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)951-960
Number of pages10
JournalEuropean Spine Journal
Issue number5
Publication statusPublished - Jan 1 2019


  • Automated analysis
  • Biplanar radiographs
  • Coordinate regression
  • Deep learning
  • Spine deformities

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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