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

  • Fabio GalbuseraEmail author
  • Frank Niemeyer
  • Hans-Joachim Wilke
  • Tito Bassani
  • Gloria Casaroli
  • Carla Anania
  • Francesco Costa
  • Marco Brayda-Bruno
  • Luca Maria Sconfienza
Original Article



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.


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.


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).


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.


Deep learning Spine deformities Automated analysis Coordinate regression Biplanar radiographs 



The work has been partially funded by the Italian Ministry of Health (Ricerca Corrente). We gratefully acknowledge the support of NVIDIA Corporation with the donation of the Titan Xp GPU used for this research.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.

Supplementary material

586_2019_5944_MOESM1_ESM.pptx (793 kb)
Supplementary material 1 (PPTX 792 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fabio Galbusera
    • 1
    Email author
  • Frank Niemeyer
    • 2
  • Hans-Joachim Wilke
    • 2
  • Tito Bassani
    • 1
  • Gloria Casaroli
    • 1
  • Carla Anania
    • 3
  • Francesco Costa
    • 3
  • Marco Brayda-Bruno
    • 4
  • Luca Maria Sconfienza
    • 5
    • 6
  1. 1.Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
  2. 2.Institute of Orthopedic Research and Biomechanics, Center for Trauma Research UlmUlm UniversityUlmGermany
  3. 3.Department of NeurosurgeryHumanitas Research HospitalRozzanoItaly
  4. 4.Department of Spine Surgery IIIIRCCS Istituto Ortopedico GaleazziMilanItaly
  5. 5.Unit of Diagnostic and Interventional RadiologyIRCCS Istituto Ortopedico GaleazziMilanItaly
  6. 6.Department of Biomedical Sciences for HealthUniversità degli Studi di MilanoMilanItaly

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