Automated Measurement of Lumbar Lordosis on Radiographs Using Machine Learning and Computer Vision

Brian H. Cho, Deepak Kaji, Zoe B. Cheung, Ivan B. Ye, Ray Tang, Amy Ahn, Oscar Carrillo, John T. Schwartz, Aly A. Valliani, Eric K. Oermann, Varun Arvind, Daniel Ranti, Li Sun, Jun S. Kim, Samuel K. Cho

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Study Design: Cross sectional database study. Objective: To develop a fully automated artificial intelligence and computer vision pipeline for assisted evaluation of lumbar lordosis. Methods: Lateral lumbar radiographs were used to develop a segmentation neural network (n = 629). After synthetic augmentation, 70% of these radiographs were used for network training, while the remaining 30% were used for hyperparameter optimization. A computer vision algorithm was deployed on the segmented radiographs to calculate lumbar lordosis angles. A test set of radiographs was used to evaluate the validity of the entire pipeline (n = 151). Results: The U-Net segmentation achieved a test dataset dice score of 0.821, an area under the receiver operating curve of 0.914, and an accuracy of 0.862. The computer vision algorithm identified the L1 and S1 vertebrae on 84.1% of the test set with an average speed of 0.14 seconds/radiograph. From the 151 test set radiographs, 50 were randomly chosen for surgeon measurement. When compared with those measurements, our algorithm achieved a mean absolute error of 8.055° and a median absolute error of 6.965° (not statistically significant, P >.05). Conclusion: This study is the first to use artificial intelligence and computer vision in a combined pipeline to rapidly measure a sagittal spinopelvic parameter without prior manual surgeon input. The pipeline measures angles with no statistically significant differences from manual measurements by surgeons. This pipeline offers clinical utility in an assistive capacity, and future work should focus on improving segmentation network performance.

Original languageEnglish
Pages (from-to)611-618
Number of pages8
JournalGlobal Spine Journal
Issue number5
StatePublished - 1 Aug 2020


  • angle measurement
  • artificial intelligence
  • computer-assisted
  • lordosis
  • lumbar
  • machine learning
  • neural networks
  • radiographic image interpretation
  • radiography
  • sagittal balance
  • spinopelvic parameters


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