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Vertebral rotation estimation from frontal X-rays using a quasi-automated pedicle detection method



Measurement of vertebral axial rotation (VAR) is relevant for the assessment of scoliosis. Stokes method allows estimating VAR in frontal X-rays from the relative position of the pedicles and the vertebral body. This method requires identifying these landmarks for each vertebral level, which is time-consuming. In this work, a quasi-automated method for pedicle detection and VAR estimation was proposed.


A total of 149 healthy and adolescent idiopathic scoliotic (AIS) subjects were included in this retrospective study. Their frontal X-rays were collected from multiple sites and manually annotated to identify the spinal midline and pedicle positions. Then, an automated pedicle detector was developed based on image analysis, machine learning and fast manual identification of a few landmarks. VARs were calculated using the Stokes method in a validation dataset of 11 healthy (age 6–33 years) and 46 AIS subjects (age 6–16 years, Cobb 10°–46°), both from detected pedicles and those manually annotated to compare them. Sensitivity of pedicle location to the manual inputs was quantified on 20 scoliotic subjects, using 10 perturbed versions of the manual inputs.


Pedicles centers were localized with a precision of 84% and mean difference of 1.2 ± 1.2 mm, when comparing with manual identification. Comparison of VAR values between automated and manual pedicle localization yielded a signed difference of − 0.2 ± 3.4°. The uncertainty on pedicle location was smaller than 2 mm along each image axis.


The proposed method allowed calculating VAR values in frontal radiographs with minimal user intervention and robust quasi-automated pedicle localization.

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The authors are grateful to the ParisTech BiomecAM chair program on subject-specific musculoskeletal modeling for funding (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Proteor and Covea).

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Correspondence to Laurent Gajny.

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Ebrahimi, S., Gajny, L., Vergari, C. et al. Vertebral rotation estimation from frontal X-rays using a quasi-automated pedicle detection method. Eur Spine J 28, 3026–3034 (2019).

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  • Vertebral axial rotation
  • Scoliosis
  • X-rays
  • Machine learning
  • Pedicle detection