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Review Article

Artificial Intelligence

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From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging—Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment
Neurospine. 2026;23(2):293-313.   Published online April 30, 2026
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From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging—Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment
Neurospine. 2026;23(2):293-313.   Published online April 30, 2026
Close
Spine imaging represents a complex diagnostic frontier characterized by anatomical variability, motion artifacts, metallic instrumentation interference, and significant inter-reader diagnostic variability (κ=0.20 across institutions). While conventional discriminative artificial intelligence (AI) models achieve >95% accuracy in detecting degenerative changes, they remain limited by data scarcity, heterogeneous protocols, and poor generalizability. In the spine, these limitations are particularly relevant because clinical decisions can often depend on subtle distinctions (such as differentiating levels of canal or foraminal stenosis, characterizing Modic endplate changes, or assessing pedicle and vertebral morphology), where small inconsistencies can meaningfully alter management or surgical planning. Generative AI (GenAI) systems—including generative adversarial networks (GANs), diffusion models, and vision-language models (VLMs)—offer a paradigm shift by learning underlying data structures to generate high-quality synthetic outputs rather than merely classifying existing data. This narrative review, conducted using SANRA (scale for the assessment of narrative review articles) methodology across PubMed, Scopus, Embase, and Cochrane Library, examined GenAI applications in spine imaging. Eligible studies included observational designs through randomized controlled trials exploring image reconstruction, synthetic computed tomography (CT) generation, segmentation, and surgical planning applications. GAN-generated synthetic magnetic resonance imaging sequences reduce scan times by ~40% while maintaining diagnostic confidence; diffusion models enable radiation-free synthetic CT for preoperative planning; and VLMs generate structured radiology reports with hallucination rates <1.12%. However, critical barriers impede clinical translation: external validation gaps reveal AI performance collapse in real-world cohorts (sensitivity drops to 54.9% in cervical fracture detection); hallucinations and anatomical inaccuracies risk misguiding implant sizing; bias amplification magnifies demographic underrepresentation; and fragmented, small datasets lack standardized benchmarks. Technical fragility, computational demands, clinician trust deficits, and unresolved regulatory frameworks for iteratively-updating systems remain unaddressed. Successful integration requires coordinated development across 5 priorities: (1) multi-institutional datasets with cross-vendor harmonization, (2) federated learning frameworks preserving privacy, (3) uncertainty quantification and explainability tools, (4) outcome-linked clinical validation replacing technical metrics, and (5) workflow-integrated systems with DICOM-native interfaces and provenance tracking.

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  • A Commentary on “From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging—Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment”
    Fabrizio Russo, Luca Ambrosio, Gianluca Vadalà, Vincenzo Denaro
    Neurospine.2026; 23(2): 314.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the April 2026 Issue
    Inbo Han
    Neurospine.2026; 23(2): 227.     CrossRef
  • 2,093 View
  • 36 Download
  • 2 Crossref

Original Article

Artificial Intelligence

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Deep Learning-Assisted Lumbar Degeneration Evaluation Using Plain Radiographs: Development and Validation of a Novel Dual-Mechanism Architecture
Neurospine. 2026;23(2):393-403.   Published online April 30, 2026
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Deep Learning-Assisted Lumbar Degeneration Evaluation Using Plain Radiographs: Development and Validation of a Novel Dual-Mechanism Architecture
Neurospine. 2026;23(2):393-403.   Published online April 30, 2026
Close
Objective
To develop and externally validate a dual-mechanism deep learning (DL) model that integrates vertebral segmentation and lesion detection for automated evaluation of lumbar degeneration and structured report generation on plain radiographs.
Methods
In this retrospective study, 5,964 patients who underwent standing anteroposterior and lateral lumbar radiographs at a single institution and 600 patients from a public dataset (BUU-Spine) were included. Vertebral corners from T11–L5 (and S1 on lateral views) and 7 degenerative findings (scoliosis, straightened/preserved lordosis, spondylolisthesis, disc space narrowing, osteophytes, vertebral compression, and abdominal aortic calcification) were annotated by 3 spine surgeons. Two independently trained, parallel networks were developed, including a ResNet-based segmentation network and a YOLOv8-based detection network. A rule-based integration strategy reconciled both outputs and generated structured diagnostic reports. Segmentation accuracy, quantitative measurement agreement, diagnostic performance, and clinical acceptability of reports were evaluated.
Results
Intra- and interobserver landmark distances within 3 mm reached 96% and >95%, respectively. On the internal test set, the percentage of correct keypoints within 3 mm was 95.7%–98.6%, with intraclass correlation coefficients of 0.84–0.89 and Pearson correlation coefficient (r) of 0.90–0.94 for key radiographic parameters. The segmentation- and detection-based models achieved precision of 92.2%–96.9% and 91.7%–95.5%, and recall of 91.6%–94.8% and 93.3%–95.2%, respectively. Under the dual-positive condition, the integrated model yielded the highest precision (93.8%–97.3%), whereas the any-positive condition achieved the highest recall (94.1%–97.6%). Of 596 automatically generated structured reports, 557 (93.4%) were deemed clinically acceptable.
Conclusion
The proposed dual-mechanism DL framework enables accurate, multilesion assessment of lumbar degeneration and generation of clinically acceptable structured reports from plain radiographs, supporting workflow optimization in lumbar spine imaging.
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Review Article

Artificial Intelligence

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The Ever-Evolving Regulatory Landscape Concerning Development and Clinical Application of Machine Intelligence: Practical Consequences for Spine Artificial Intelligence Research
Neurospine. 2025;22(1):134-143.   Published online March 31, 2025
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The Ever-Evolving Regulatory Landscape Concerning Development and Clinical Application of Machine Intelligence: Practical Consequences for Spine Artificial Intelligence Research
Neurospine. 2025;22(1):134-143.   Published online March 31, 2025
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This paper analyzes the regulatory frameworks for artificial intelligence/machine learning AI/ML-enabled medical devices in the European Union (EU), the United States (US), and the Republic of Korea, with a focus on applications in spine surgery. The aim is to provide guidance for developers and researchers navigating regulatory pathways. A review of current literature, regulatory documents, and legislative frameworks was conducted. Key differences in regulatory bodies, risk classification, submission requirements, and approval pathways for AI/ML medical devices were examined in the EU, US, and Republic of Korea. The EU AI Act (2024) establishes a risk-based framework, requiring regulatory review based on device risk, with high-risk devices subject to stricter oversight. The US applies a more flexible approach, allowing multiple submission pathways and incorporating a focus on continuous learning. The Republic of Korea emphasizes possibilities of streamlined approval and with growing use of real-world data to support validation. Developers must ensure regulatory alignment early in the development process, focusing on key aspects like dataset quality, transparency, and continuous monitoring. Across all regions, the need for technical documentation, quality management systems, and bias mitigation are essential for approval. Developers are encouraged to adopt adaptable strategies to comply with evolving regulatory standards, ensuring models remain transparent, fair, and reliable. The EU’s comprehensive AI Act enforces stricter oversight, while the US and Korea offer more flexible pathways. Developers of spine surgery AI/ML devices must tailor development strategies to align with regional regulations, emphasizing transparent development, quality assurance, and postmarket monitoring to ensure approval success.

Citations

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  • Artificial intelligence in spine surgery: a scoping review
    Anis Choucha, Morgane Evin, Matteo de Simone, Guillaume Dannhoff, Henry Dufour, Valentin Avinens, Kaissar Farah, Florian Saby, Stephane Fuentes
    Neurochirurgie.2026; 72(1): 101764.     CrossRef
  • Applications of Raman Spectroscopy in Pandemic Virology: A Comprehensive Review
    Hulya Yilmaz, Anuradha Ramoji, Andreea Winterfeld, Hamideh Salehi, Aykut Ozkul, Jürgen Popp
    ACS Photonics.2026; 13(6): 1568.     CrossRef
  • Application of artificial intelligence in diagnosis and treatment of spinal deformities
    Chunwang Jia, Haoming Sun, Zhenhao Chen, Yubao Hou, Jiyu Li, Xiaosheng Ma, Feizhou Lyu, Jianyuan Jiang, Yu Chen, Hongli Wang
    Spine Research.2026; 2(2): 110.     CrossRef
  • Current Applications and Future Directions of Technologies Used in Adult Deformity Surgery for Personalized Alignment: A Narrative Review
    Janet Hsu, Taikhoom M. Dahodwala, Noel O. Akioyamen, Evan Mostafa, Rami Z. AbuQubo, Xiuyi Alexander Yang, Priya K. Singh, Daniel C. Berman, Rafael De la Garza Ramos, Yaroslav Gelfand, Saikiran G. Murthy, Jonathan D. Krystal, Ananth S. Eleswarapu, Mitchell
    Journal of Personalized Medicine.2025; 15(10): 480.     CrossRef
  • 8,905 View
  • 627 Download
  • 2 Web of Science
  • 4 Crossref

Original Article

Special Issue With Global Spine Journal

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Artificial Intelligence Detection of Cervical Spine Fractures Using Convolutional Neural Network Models
Neurospine. 2024;21(3):833-841.   Published online September 30, 2024
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Artificial Intelligence Detection of Cervical Spine Fractures Using Convolutional Neural Network Models
Neurospine. 2024;21(3):833-841.   Published online September 30, 2024
Close
Objective
To develop and evaluate a technique using convolutional neural networks (CNNs) for the computer-assisted diagnosis of cervical spine fractures from radiographic x-ray images. By leveraging deep learning techniques, the study might potentially lead to improved patient outcomes and clinical decision-making.
Methods
This study obtained 500 lateral radiographic cervical spine x-ray images from standard open-source dataset repositories to develop a classification model using CNNs. All the images contained diagnostic information, including normal cervical radiographic images (n=250) and fracture images of the cervical spine fracture (n=250). The model would classify whether the patient had a cervical spine fracture or not. Seventy percent of the images were training data sets used for model training, and 30% were for testing. Konstanz Information Miner (KNIME)’s graphic user interface-based programming enabled class label annotation, data preprocessing, CNNs model training, and performance evaluation.
Results
The performance evaluation of a model for detecting cervical spine fractures presents compelling results across various metrics. This model exhibits high sensitivity (recall) values of 0.886 for fractures and 0.957 for normal cases, indicating its proficiency in identifying true positives. Precision values of 0.954 for fractures and 0.893 for normal cases highlight the model’s ability to minimize false positives. With specificity values of 0.957 for fractures and 0.886 for normal cases, the model effectively identifies true negatives. The overall accuracy of 92.14% highlights its reliability in correctly classifying cases by the area under the receiver operating characteristic curve.
Conclusion
We successfully used deep learning models for computer-assisted diagnosis of cervical spine fractures from radiographic x-ray images. This approach can assist the radiologist in screening, detecting, and diagnosing cervical spine fractures.

Citations

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  • A Multi-Context Squeeze-Excitation Framework with Explainable Attention for Cervical Spine Fracture Detection in CT Imaging
    M. Anitha, P. Tamije Selvy
    Iranian Journal of Science and Technology, Transactions of Electrical Engineering.2026; 50(2): 1457.     CrossRef
  • Artificial intelligence in spine surgery: a scoping review
    Anis Choucha, Morgane Evin, Matteo de Simone, Guillaume Dannhoff, Henry Dufour, Valentin Avinens, Kaissar Farah, Florian Saby, Stephane Fuentes
    Neurochirurgie.2026; 72(1): 101764.     CrossRef
  • Contrastive Learning-Driven Representation and Feature Selection for Spinal Fracture Detection on CT Images
    Hasan Genç, Canan Koç, Esra Yüzgeç Özdemír, Fatíh Özyurt
    IEEE Access.2026; 14: 8047.     CrossRef
  • Clinical Application of Deep Learning for Spine MRI Interpretation: A Multicenter Evaluation of Artificial-Intelligence-Assisted versus Manual Reading on Diagnostic Agreement with the Reference Standard
    Xing Cheng, Maoping Zhang, Zhenxiao Ren, Tang Tang, Xiaolin Meng, Zhong Huang, Hongwei Bran Li, Weiguo Li, Qiuchan Yan, Haixiong Chen, Jie Jia, Ce Wang, Cheng Li, Chunshan Yang, Guifeng Shi, Guohua Li, Kaixin Zeng, Wei Chen, Haoxuan Gao, Xiaobo Wang, Xin
    Research.2026;[Epub]     CrossRef
  • A two-stage deep learning system for cervical spine fracture diagnosis: integrating 3D segmentation and 2.5D classification on CT images
    Renyi Lu, Yuying Feng, Ruozhou Wang, Ting Song
    European Spine Journal.2026;[Epub]     CrossRef
  • Diagnostic performance of artificial intelligence for identification of cervical spine fractures: a systematic review and meta-analysis
    Ali Gholamrezanezhad, Mehrdad Farrokhi, Sami Almasri, Hadis Askari, Ali Askari, Seyed Arshia Mirjafarifiroozabadi, Mohammad Amin Nochian, Eashan Kosaraju
    Emergency Radiology.2026; 33(4): 889.     CrossRef
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    Vinod Biradar, Kuppala Saritha, Anusha Preetham
    European Spine Journal.2026;[Epub]     CrossRef
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    Wongthawat Liawrungrueang, Watcharaporn Cholamjiak, Arunee Promsri, Khanathip Jitpakdee, Sompoom Sunpaweravong, Vit Kotheeranurak, Peem Sarasombath
    Global Spine Journal.2025; 15(4): 2547.     CrossRef
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    Wongthawat Liawrungrueang, Sung Tan Cho, Watcharaporn Cholamjiak, Peem Sarasombath, Nattaphon Twinprai, Prin Twinprai, Inbo Han
    Asian Spine Journal.2025; 19(1): 148.     CrossRef
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    Hongyan Wang, Jie Lu, Song Yang, Yin Xiao, Liangliang He, Zhi Dou, Wenxing Zhao, Liqiang Yang
    DIGITAL HEALTH.2025;[Epub]     CrossRef
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    Wongthawat Liawrungrueang
    Neurospine.2025; 22(2): 473.     CrossRef
  • Fully automated pedicle screw manufacturer identification in plain radiograph with deep learning methods
    Rattapoom Waranusast, Panomkhawn Riyamongkol, Santi Weerakul, Nattharut Chaibhuddanugul, Artit Laoruengthana, Akaworn Mahatthanatrakul
    European Spine Journal.2025; 34(9): 3940.     CrossRef
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    Youngbeom Seo, Heesung Yang, Eunjung Kong, Vivek Sanker, Atman Desai, Jungwon Lee, So Hee Park, You Seon Song, Ikchan Jeon
    Neuroradiology.2025; 67(10): 2727.     CrossRef
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    Abdulhamit Misir
    Injury.2025; 56(8): 112570.     CrossRef
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    Seonghoon Jeong, Byung-Jou Lee
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    Rahul Kumar, Conor Dougherty, Kyle Sporn, Akshay Khanna, Puja Ravi, Pranay Prabhakar, Nasif Zaman
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    Frontiers in Neurology.2025;[Epub]     CrossRef
  • From the Editor-in-Chief: Featured Articles in the September 2024 Issue
    Inbo Han
    Neurospine.2024; 21(3): 743.     CrossRef
  • Commentary on “Artificial Intelligence Detection of Cervical Spine Fractures Using Convolutional Neural Network Models”
    Yu-Cheng Yeh, Fon-Yih Tsuang
    Neurospine.2024; 21(3): 842.     CrossRef
  • 8,740 View
  • 191 Download
  • 20 Web of Science
  • 19 Crossref

Review Article

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Artificial Intelligence in Spinal Imaging and Patient Care: A Review of Recent Advances
Neurospine. 2024;21(2):474-486.   Published online June 30, 2024
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Artificial Intelligence in Spinal Imaging and Patient Care: A Review of Recent Advances
Neurospine. 2024;21(2):474-486.   Published online June 30, 2024
Close
Artificial intelligence (AI) is transforming spinal imaging and patient care through automated analysis and enhanced decision-making. This review presents a clinical task-based evaluation, highlighting the specific impact of AI techniques on different aspects of spinal imaging and patient care. We first discuss how AI can potentially improve image quality through techniques like denoising or artifact reduction. We then explore how AI enables efficient quantification of anatomical measurements, spinal curvature parameters, vertebral segmentation, and disc grading. This facilitates objective, accurate interpretation and diagnosis. AI models now reliably detect key spinal pathologies, achieving expert-level performance in tasks like identifying fractures, stenosis, infections, and tumors. Beyond diagnosis, AI also assists surgical planning via synthetic computed tomography generation, augmented reality systems, and robotic guidance. Furthermore, AI image analysis combined with clinical data enables personalized predictions to guide treatment decisions, such as forecasting spine surgery outcomes. However, challenges still need to be addressed in implementing AI clinically, including model interpretability, generalizability, and data limitations. Multicenter collaboration using large, diverse datasets is critical to advance the field further. While adoption barriers persist, AI presents a transformative opportunity to revolutionize spinal imaging workflows, empowering clinicians to translate data into actionable insights for improved patient care.

Citations

Citations to this article as recorded by  Crossref logo
  • Evaluating the Diagnostic Accuracy of Artificial Intelligence in Spondylolisthesis Detection: A Systematic Review and Meta-analysis
    Mohammad-Taha Pahlevan-Fallahy, Amir-Mohammad Asgari, Alireza Soltani Khaboushan, Majid Chalian, Farhad Shaker, Parnian Yari, Sara Haseli
    Academic Radiology.2026; 33(3): 1034.     CrossRef
  • MRI evaluation of the lumbar spine: a survey-based assessment of protocols and practice patterns used by musculoskeletal radiologists in the United States
    Patrick Debs, Mona Dabiri, Robert D. Boutin, Stacy Smith, Thomas M. Link, Laura M. Fayad
    Skeletal Radiology.2026; 55(3): 579.     CrossRef
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    Jimmy Wen, Megan Kou, Ihab Abed, David Park, Zohaer Muttalib, Arsh Alam, Foad Elahi
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  • Artificial intelligence in spine surgery: a scoping review
    Anis Choucha, Morgane Evin, Matteo de Simone, Guillaume Dannhoff, Henry Dufour, Valentin Avinens, Kaissar Farah, Florian Saby, Stephane Fuentes
    Neurochirurgie.2026; 72(1): 101764.     CrossRef
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    Jacob Weinberg, John Bonamer, Nicolas Kelhofer, Mohamed Ali Jawad-Makki, Ryan Zuckerbraun, Christopher Gonzalez, Rahul Ramanathan, Joon Y. Lee, Michael Spitnale, Richard Wawrose
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    Roxana Florea, Ki-Soo Jeong, Carl Y. Saab
    Experimental Neurology.2026; 398: 115649.     CrossRef
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    SN Comprehensive Clinical Medicine.2026;[Epub]     CrossRef
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    Victoria A. Bensel, Anne Habeck, Marcda Hilaire Brunot, Eleni-James Becton, Monika Ray, Alexandria L. Brackett, Anthony J. Lisi, Rajakumar Anbazhagan
    PLOS One.2026; 21(7): e0352200.     CrossRef
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    Liling Zhou, Sirui Zhou, Weijian Zhu, Qi Zhou, Zhihao Xu, Gang Wu
    DIGITAL HEALTH.2026;[Epub]     CrossRef
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    Xiao Qu, Yucheng Shu, Huazhang Zhu, Chao Zhang, Dagang Tang, Ningdao Li, Xiaoji Luo
    Health Informatics Journal.2026;[Epub]     CrossRef
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    Chenlu Rao, Jinming Wang, Xiaojuan Ma, Meiyuan Hu, Jiaxin Zhang, Ying Xu, Wenjuan Zhou
    Journal of Biosciences and Medicines.2026; 14(06): 92.     CrossRef
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    Bong-Su Mun, Zhi Zhao, Sang-Min Park, Jiwon Park, Hyun-Jin Park, Hyung Rae Lee, Ho-Joong Kim, Jin S. Yeom
    Neurospine.2026; 23(3): 633.     CrossRef
  • DeepSeek versus ChatGPT: Multimodal artificial intelligence revolutionizing scientific discovery. From language editing to autonomous content generation—Redefining innovation in research and practice
    Mahmut Enes Kayaalp, Robert Prill, Erdem Aras Sezgin, Ting Cong, Aleksandra Królikowska, Michael T. Hirschmann
    Knee Surgery, Sports Traumatology, Arthroscopy.2025; 33(5): 1553.     CrossRef
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    Sebastian Encalada, Sahil Gupta, Christine Hunt, Jason Eldrige, John Evans, Johanna Mosquera-Moscoso, Laura Furtado Pessoa de Mendonca, Sharima Kanahan-Osman, Sohail Bade, Sahil Bade, Lisbet Ivicic, Stephanie Foskey, Jason Lyles, Juan Suarez, Aaron Fisher
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Analyzing Large Language Models’ Responses to Common Lumbar Spine Fusion Surgery Questions: A Comparison Between ChatGPT and Bard
Neurospine. 2024;21(2):633-641.   Published online June 30, 2024
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Analyzing Large Language Models’ Responses to Common Lumbar Spine Fusion Surgery Questions: A Comparison Between ChatGPT and Bard
Neurospine. 2024;21(2):633-641.   Published online June 30, 2024
Close
Objective
In the digital age, patients turn to online sources for lumbar spine fusion information, necessitating a careful study of large language models (LLMs) like chat generative pre-trained transformer (ChatGPT) for patient education.
Methods
Our study aims to assess the response quality of Open AI (artificial intelligence)’s ChatGPT 3.5 and Google’s Bard to patient questions on lumbar spine fusion surgery. We identified 10 critical questions from 158 frequently asked ones via Google search, which were then presented to both chatbots. Five blinded spine surgeons rated the responses on a 4-point scale from ‘unsatisfactory’ to ‘excellent.’ The clarity and professionalism of the answers were also evaluated using a 5-point Likert scale.
Results
In our evaluation of 10 questions across ChatGPT 3.5 and Bard, 97% of responses were rated as excellent or satisfactory. Specifically, ChatGPT had 62% excellent and 32% minimally clarifying responses, with only 6% needing moderate or substantial clarification. Bard’s responses were 66% excellent and 24% minimally clarifying, with 10% requiring more clarification. No significant difference was found in the overall rating distribution between the 2 models. Both struggled with 3 specific questions regarding surgical risks, success rates, and selection of surgical approaches (Q3, Q4, and Q5). Interrater reliability was low for both models (ChatGPT: k = 0.041, p = 0.622; Bard: k = -0.040, p = 0.601). While both scored well on understanding and empathy, Bard received marginally lower ratings in empathy and professionalism.
Conclusion
ChatGPT3.5 and Bard effectively answered lumbar spine fusion FAQs, but further training and research are needed to solidify LLMs’ role in medical education and healthcare communication.

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Deep Learning-Assisted Quantitative Measurement of Thoracolumbar Fracture Features on Lateral Radiographs
Neurospine. 2024;21(1):30-43.   Published online March 31, 2024
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Deep Learning-Assisted Quantitative Measurement of Thoracolumbar Fracture Features on Lateral Radiographs
Neurospine. 2024;21(1):30-43.   Published online March 31, 2024
Close
Objective
This study aimed to develop and validate a deep learning (DL) algorithm for the quantitative measurement of thoracolumbar (TL) fracture features, and to evaluate its efficacy across varying levels of clinical expertise.
Methods
Using the pretrained Mask Region-Based Convolutional Neural Networks model, originally developed for vertebral body segmentation and fracture detection, we fine-tuned the model and added a new module for measuring fracture metrics—compression rate (CR), Cobb angle (CA), Gardner angle (GA), and sagittal index (SI)—from lumbar spine lateral radiographs. These metrics were derived from six-point labeling by 3 radiologists, forming the ground truth (GT). Training utilized 1,000 nonfractured and 318 fractured radiographs, while validations employed 213 internal and 200 external fractured radiographs. The accuracy of the DL algorithm in quantifying fracture features was evaluated against GT using the intraclass correlation coefficient. Additionally, 4 readers with varying expertise levels, including trainees and an attending spine surgeon, performed measurements with and without DL assistance, and their results were compared to GT and the DL model.
Results
The DL algorithm demonstrated good to excellent agreement with GT for CR, CA, GA, and SI in both internal (0.860, 0.944, 0.932, and 0.779, respectively) and external (0.836, 0.940, 0.916, and 0.815, respectively) validations. DL-assisted measurements significantly improved most measurement values, particularly for trainees.
Conclusion
The DL algorithm was validated as an accurate tool for quantifying TL fracture features using radiographs. DL-assisted measurement is expected to expedite the diagnostic process and enhance reliability, particularly benefiting less experienced clinicians.

Citations

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    Neurochirurgie.2026; 72(1): 101764.     CrossRef
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    Vibhu Krishnan Viswanathan, Vijay Kumar Jain, Subramanian Surabhi, Karthikeyan P. Iyengar
    Apollo Medicine.2026; 23(1): 46.     CrossRef
  • Who Is the Surgeon Now: Human Hands or Machine Minds? Artificial Intelligence in Orthopedics from Diagnosis to Follow-Up—A Structured Narrative Review
    Furkan Yapıcı
    Journal of Clinical Medicine.2026; 15(6): 2165.     CrossRef
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    Kaixuan Chen, Yizhong Ma, Zihui Yang, Hongfeng Ruan, Guanyi Liu
    Orthopaedic Surgery.2026; 18(5): 1085.     CrossRef
  • Deep Learning-Assisted Lumbar Degeneration Evaluation Using Plain Radiographs: Development and Validation of a Novel Dual-Mechanism Architecture
    Ziqian Ma, Aobo Wang, Xingyu Liu, Ruiyuan Chen, Tianyi Wang, Yu Xi, Minghui Liang, Ning Fan, Shuo Yuan, Peng Du, Dong Liu, Yiling Zhang, Lei Zang
    Neurospine.2026; 23(2): 393.     CrossRef
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    Woon Tak Yuh, Seung-Jun Ryu, Tae-Shin Kim, Il Choi
    Journal of Korean Neurosurgical Society.2026; 69(4): 496.     CrossRef
  • The Application of Artificial Intelligence in Spine Surgery: A Scoping Review
    Liangyu Shi, Hongfei Wang, Graham Ka-Hon Shea
    JAAOS: Global Research and Reviews.2025;[Epub]     CrossRef
  • Commentary on “Deep Learning-Assisted Quantitative Measurement of Thoracolumbar Fracture Features on Lateral Radiographs”
    Chao-Hung Kuo
    Neurospine.2024; 21(1): 44.     CrossRef
  • Application and Prospects of Deep Learning Technology in Fracture Diagnosis
    Jia-yao Zhang, Jia-ming Yang, Xin-meng Wang, Hong-lin Wang, Hong Zhou, Zi-neng Yan, Yi Xie, Peng-ran Liu, Zhi-wei Hao, Zhe-wei Ye
    Current Medical Science.2024; 44(6): 1132.     CrossRef
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Performance of a Large Language Model in the Generation of Clinical Guidelines for Antibiotic Prophylaxis in Spine Surgery
Neurospine. 2024;21(1):128-146.   Published online March 31, 2024
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Performance of a Large Language Model in the Generation of Clinical Guidelines for Antibiotic Prophylaxis in Spine Surgery
Neurospine. 2024;21(1):128-146.   Published online March 31, 2024
Close
Objective
Large language models, such as chat generative pre-trained transformer (ChatGPT), have great potential for streamlining medical processes and assisting physicians in clinical decision-making. This study aimed to assess the potential of ChatGPT’s 2 models (GPT-3.5 and GPT-4.0) to support clinical decision-making by comparing its responses for antibiotic prophylaxis in spine surgery to accepted clinical guidelines.
Methods
ChatGPT models were prompted with questions from the North American Spine Society (NASS) Evidence-based Clinical Guidelines for Multidisciplinary Spine Care for Antibiotic Prophylaxis in Spine Surgery (2013). Its responses were then compared and assessed for accuracy.
Results
Of the 16 NASS guideline questions concerning antibiotic prophylaxis, 10 responses (62.5%) were accurate in ChatGPT’s GPT-3.5 model and 13 (81%) were accurate in GPT-4.0. Twenty-five percent of GPT-3.5 answers were deemed as overly confident while 62.5% of GPT-4.0 answers directly used the NASS guideline as evidence for its response.
Conclusion
ChatGPT demonstrated an impressive ability to accurately answer clinical questions. GPT-3.5 model’s performance was limited by its tendency to give overly confident responses and its inability to identify the most significant elements in its responses. GPT-4.0 model’s responses had higher accuracy and cited the NASS guideline as direct evidence many times. While GPT-4.0 is still far from perfect, it has shown an exceptional ability to extract the most relevant research available compared to GPT-3.5. Thus, while ChatGPT has shown far-reaching potential, scrutiny should still be exercised regarding its clinical use at this time.

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    Global Spine Journal.2025; 15(7): 3199.     CrossRef
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    npj Antimicrobials and Resistance.2025;[Epub]     CrossRef
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    World Neurosurgery.2025; 196: 123755.     CrossRef
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    Daniel E. Herrera, Arun Movva, Kaitlyn Hurka, James G. Lyman, Rushmin Khazanchi, Mark A. Plantz, Tyler Compton, Jason Tegethoff, Parth Desai, Srikanth N. Divi, Wellington K. Hsu, Alpesh A. Patel
    Contemporary Spine Surgery.2025; 26(4): 1.     CrossRef
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    Arthroscopy.2025; 41(11): 4928.     CrossRef
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Whole Spine Segmentation Using Object Detection and Semantic Segmentation
Neurospine. 2024;21(1):57-67.   Published online February 1, 2024
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Whole Spine Segmentation Using Object Detection and Semantic Segmentation
Neurospine. 2024;21(1):57-67.   Published online February 1, 2024
Close
Objective
Virtual and augmented reality have enjoyed increased attention in spine surgery. Preoperative planning, pedicle screw placement, and surgical training are among the most studied use cases. Identifying osseous structures is a key aspect of navigating a 3-dimensional virtual reconstruction. To automate the otherwise time-consuming process of labeling vertebrae on each slice individually, we propose a fully automated pipeline that automates segmentation on computed tomography (CT) and which can form the basis for further virtual or augmented reality application and radiomic analysis.
Methods
Based on a large public dataset of annotated vertebral CT scans, we first trained a YOLOv8m (You-Only-Look-Once algorithm, Version 8 and size medium) to detect each vertebra individually. On the then cropped images, a 2D-U-Net was developed and externally validated on 2 different public datasets.
Results
Two hundred fourteen CT scans (cervical, thoracic, or lumbar spine) were used for model training, and 40 scans were used for external validation. Vertebra recognition achieved a mAP50 (mean average precision with Jaccard threshold of 0.5) of over 0.84, and the segmentation algorithm attained a mean Dice score of 0.75 ± 0.14 at internal, 0.77 ± 0.12 and 0.82 ± 0.14 at external validation, respectively.
Conclusion
We propose a 2-stage approach consisting of single vertebra labeling by an object detection algorithm followed by semantic segmentation. In our externally validated pilot study, we demonstrate robust performance for our object detection network in identifying individual vertebrae, as well as for our segmentation model in precisely delineating the bony structures.

Citations

Citations to this article as recorded by  Crossref logo
  • Enhancing lumbar disc herniation classification through region-of-interest guidance and geometric shape features
    Cong Zhang, Kunjin He, Wei Xu, Xiaoqing Gu, Zhengming Chen, Yiping Weng
    Biomedical Physics & Engineering Express.2026; 12(1): 015038.     CrossRef
  • Artificial intelligence in spine surgery: a scoping review
    Anis Choucha, Morgane Evin, Matteo de Simone, Guillaume Dannhoff, Henry Dufour, Valentin Avinens, Kaissar Farah, Florian Saby, Stephane Fuentes
    Neurochirurgie.2026; 72(1): 101764.     CrossRef
  • Deep Learning-Based Projection Angle Estimation for Lumbar Oblique Radiography: A Two-Stage Object Detection Approach Using Vertebral–Pedicle Ratio Analysis
    Riria Yamamoto, Kaori Tsutsumi, Takaaki Yoshimura, Hiroyuki Sugimori
    Applied Sciences.2026; 16(6): 2800.     CrossRef
  • AI applications in lumbar and lumbosacral pedicle screw placement: a systematic review of limited evidence and future directions
    Pakpoom Thintharua, Ratchaphon Prabrai, Anuyut khamsiriwatchara, Rohan Sethi, Sorayouth Chumnanvej
    Neurosurgical Review.2026;[Epub]     CrossRef
  • Vertebra-Level Completeness Analysis in Thoracolumbar Ultrasound Using a YOLO-Based Detection Framework
    Sumartini Dana, Chen Zhang, Yongping Zheng, Sai Ho Ling
    Sensors.2026; 26(7): 2101.     CrossRef
  • Segmentation and 3D Visualization of Spinal Motion Segments from MSCT Images Using a 3D U‑Net Framework
    Antor Mahamudul Hashan, Khlebnikov Nikolai Alexandrovich, Denis Protasov
    Journal of Imaging Informatics in Medicine.2026;[Epub]     CrossRef
  • Dual-cooperation of spatial and local cues enhances point-supervised spinal structure segmentation
    Pei Wang, Jiansong Fan, Xiang Pan, Wei Chu
    Applied Soft Computing.2026; 202: 115993.     CrossRef
  • The Application of Artificial Intelligence in Spine Surgery: A Scoping Review
    Liangyu Shi, Hongfei Wang, Graham Ka-Hon Shea
    JAAOS: Global Research and Reviews.2025;[Epub]     CrossRef
  • Can artificial intelligence in spine imaging affect current practice? Practical developments and their clinical status
    Yu-Cherng Chang, Cinthia Del Toro, Joseph P. Gjolaj, Thiago A. Braga, Ty K. Subhawong
    North American Spine Society Journal (NASSJ).2025; 23: 100621.     CrossRef
  • Mask prompt-guided multi-stage network for vertebrae identification
    Zhikai Zhou, Ziyue Zhang, Mingying Li, Lei Song, Youyong Kong, Jean Louis Coatrieux, Huazhong Shu
    Biomedical Signal Processing and Control.2025; 110: 108091.     CrossRef
  • Empowering the future of spinal surgery through digital and intelligent technologies
    Chenfei Gao, Tianyu Yao, Tenghui Zhang, Wenyu Zhang, Jianxi Wang, Fazhi Zang, Huajiang Chen
    Spine Research.2025; 1(1): 23.     CrossRef
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    Zhuofan Xie, Zishan Lin, Enlong Sun, Fengyi Ding, Jie Qi, Shen Zhao
    Computerized Medical Imaging and Graphics.2025; 125: 102652.     CrossRef
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    Nitzan Kenig, Javier Monton Echeverria, Aina Muntaner Vives
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  • 14,309 View
  • 287 Download
  • 13 Web of Science
  • 13 Crossref

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TomoRay: Generating Synthetic Computed Tomography of the Spine From Biplanar Radiographs
Neurospine. 2024;21(1):68-75.   Published online February 1, 2024
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TomoRay: Generating Synthetic Computed Tomography of the Spine From Biplanar Radiographs
Neurospine. 2024;21(1):68-75.   Published online February 1, 2024
Close
Objective
Computed tomography (CT) imaging is a cornerstone in the assessment of patients with spinal trauma and in the planning of spinal interventions. However, CT studies are associated with logistical problems, acquisition costs, and radiation exposure. In this proof-of-concept study, the feasibility of generating synthetic spinal CT images using biplanar radiographs was explored. This could expand the potential applications of x-ray machines pre-, post-, and even intraoperatively.
Methods
A cohort of 209 patients who underwent spinal CT imaging from the VerSe2020 dataset was used to train the algorithm. The model was subsequently evaluated using an internal and external validation set containing 55 from the VerSe2020 dataset and a subset of 56 images from the CTSpine1K dataset, respectively. Digitally reconstructed radiographs served as input for training and evaluation of the 2-dimensional (2D)-to-3-dimentional (3D) generative adversarial model. Model performance was assessed using peak signal to noise ratio (PSNR), structural similarity index (SSIM), and cosine similarity (CS).
Results
At external validation, the developed model achieved a PSNR of 21.139 ± 1.018 dB (mean ± standard deviation). The SSIM and CS amounted to 0.947 ± 0.010 and 0.671 ± 0.691, respectively.
Conclusion
Generating an artificial 3D output from 2D imaging is challenging, especially for spinal imaging, where x-rays are known to deliver insufficient information frequently. Although the synthetic CT scans derived from our model do not perfectly match their ground truth CT, our proof-of-concept study warrants further exploration of the potential of this technology.

Citations

Citations to this article as recorded by  Crossref logo
  • Artificial intelligence in spine surgery: a scoping review
    Anis Choucha, Morgane Evin, Matteo de Simone, Guillaume Dannhoff, Henry Dufour, Valentin Avinens, Kaissar Farah, Florian Saby, Stephane Fuentes
    Neurochirurgie.2026; 72(1): 101764.     CrossRef
  • TomoRay cranial: synthesis of cranial CT imaging from biplanar radiographs using a generative adversarial network
    Olivier Zanier, Seungjun Ryu, Raffaele Da Mutten, Sven Theiler, Alessandro Carretta, Giorgio Palandri, Diego Mazzatenta, Luca Regli, Carlo Serra, Victor E. Staartjes
    European Radiology.2026; 36(6): 4873.     CrossRef
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    Victor E. Staartjes, Massimo Bottini, Olivier Zanier, Luca Regli, Carlo Serra
    World Neurosurgery.2026; 206: 124740.     CrossRef
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    Jinlei Liu, Fuyao Yu, Rui Li, Xiaohong Lyu, Shilei Zheng
    IEEE Internet of Things Journal.2026; 13(5): 7862.     CrossRef
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    Daniel De Wilde, Olivier Zanier, Raffaele Da Mutten, Michael Jin, Luca Regli, Carlo Serra, Victor E. Staartjes
    Medical Image Analysis.2025; 101: 103454.     CrossRef
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    Youngbeom Seo, Heesung Yang, Eunjung Kong, Vivek Sanker, Atman Desai, Jungwon Lee, So Hee Park, You Seon Song, Ikchan Jeon
    Neuroradiology.2025; 67(10): 2727.     CrossRef
  • Generation of synthetic tomographic images from biplanar X-ray: a narrative review of history, methods, and the state of the art
    Aron ALAKMEH, Olivier ZANIER, Massimo BOTTINI, Maria L. GANDIA-GONZALEZ, Gustav BURSTRÖM, Erik EDSTRÖM, Adrian ELMI TERANDER, Ethan SCHONFELD, Anand VEERAVAGU, Luca REGLI, Carlo SERRA, Victor E. STAARTJES
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  • From the Editor-in-Chief: Featured Articles in the March 2024 Issue
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    Yuepeng Chen, Yue Gao, Xiangling Fu, Yingyin Chen, Ji Wu, Chenyi Guo, Xiaodong Li
    Scientific Reports.2024;[Epub]     CrossRef
  • Enabling Technologies in the Management of Cervical Spine Trauma
    Arjun K. Menta, Antony A. Fuleihan, Marvin Li, Tej D. Azad, Timothy F. Witham
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  • 7,122 View
  • 208 Download
  • 13 Web of Science
  • 10 Crossref

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Use of ChatGPT for Determining Clinical and Surgical Treatment of Lumbar Disc Herniation With Radiculopathy: A North American Spine Society Guideline Comparison
Neurospine. 2024;21(1):149-158.   Published online January 31, 2024
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Use of ChatGPT for Determining Clinical and Surgical Treatment of Lumbar Disc Herniation With Radiculopathy: A North American Spine Society Guideline Comparison
Neurospine. 2024;21(1):149-158.   Published online January 31, 2024
Close
Objective
Large language models like chat generative pre-trained transformer (ChatGPT) have found success in various sectors, but their application in the medical field remains limited. This study aimed to assess the feasibility of using ChatGPT to provide accurate medical information to patients, specifically evaluating how well ChatGPT versions 3.5 and 4 aligned with the 2012 North American Spine Society (NASS) guidelines for lumbar disk herniation with radiculopathy.
Methods
ChatGPT's responses to questions based on the NASS guidelines were analyzed for accuracy. Three new categories—overconclusiveness, supplementary information, and incompleteness—were introduced to deepen the analysis. Overconclusiveness referred to recommendations not mentioned in the NASS guidelines, supplementary information denoted additional relevant details, and incompleteness indicated omitted crucial information from the NASS guidelines.
Results
Out of 29 clinical guidelines evaluated, ChatGPT-3.5 demonstrated accuracy in 15 responses (52%), while ChatGPT-4 achieved accuracy in 17 responses (59%). ChatGPT-3.5 was overconclusive in 14 responses (48%), while ChatGPT-4 exhibited overconclusiveness in 13 responses (45%). Additionally, ChatGPT-3.5 provided supplementary information in 24 responses (83%), and ChatGPT-4 provided supplemental information in 27 responses (93%). In terms of incompleteness, ChatGPT-3.5 displayed this in 11 responses (38%), while ChatGPT-4 showed incompleteness in 8 responses (23%).
Conclusion
ChatGPT shows promise for clinical decision-making, but both patients and healthcare providers should exercise caution to ensure safety and quality of care. While these results are encouraging, further research is necessary to validate the use of large language models in clinical settings.

Citations

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    European Spine Journal.2026; 35(3): 1301.     CrossRef
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    Ahmet Kartal, Noel F. Manalil, Chiungwen D. Cheng, Lawrance K. Chung, Harry Gebhard, Michael Greenberg, Roger Härtl, Galal A. Elsayed
    Global Spine Journal.2026; 16(6): 2611.     CrossRef
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    Neurochirurgie.2026; 72(1): 101764.     CrossRef
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    Medicine.2026; 105(5): e47493.     CrossRef
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Conversational Artificial Intelligence for Spinal Pain Questionnaire: Validation and User Satisfaction
Neurospine. 2022;19(2):348-356.   Published online May 12, 2022
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Conversational Artificial Intelligence for Spinal Pain Questionnaire: Validation and User Satisfaction
Neurospine. 2022;19(2):348-356.   Published online May 12, 2022
Close
Objective
The purpose of our study is to develop a spoken dialogue system (SDS) for pain questionnaire in patients with spinal disease. We evaluate user satisfaction and validated the performance accuracy of the SDS in medical staff and patients.
Methods
The SDS was developed to investigate pain and related psychological issues in patients with spinal diseases based on the pain questionnaire protocol. We recognized patients’ various answers, summarized important information, and documented them. User satisfaction and performance accuracy were evaluated in 30 potential users of SDS, including doctors, nurses, and patients and statistically analyzed.
Results
The overall satisfaction score of 30 patients was 5.5 ± 1.4 out of 7 points. Satisfaction scores were 5.3 ± 0.8 for doctors, 6.0 ± 0.6 for nurses, and 5.3 ± 0.5 for patients. In terms of performance accuracy, the number of repetitions of the same question was 13, 16, and 33 (13.5%, 16.8%, and 34.7%) for doctors, nurses, and patients, respectively. The number of errors in the summarized comment by the SDS was 5, 0, and 11 (5.2%, 0.0%, and 11.6 %), respectively. The number of summarization omissions was 7, 5, and 7 (7.3%, 5.3%, and 7.4%), respectively.
Conclusion
This is the first study in which voice-based conversational artificial intelligence (AI) was developed for a spinal pain questionnaire and validated by medical staff and patients. The conversational AI showed favorable results in terms of user satisfaction and performance accuracy. Conversational AI can be useful for the diagnosis and remote monitoring of various patients as well as for pain questionnaires in the future.

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  • 244 Download
  • 13 Web of Science
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Emerging Technologies in the Treatment of Adult Spinal Deformity
Neurospine. 2021;18(3):417-427.   Published online September 30, 2021
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Emerging Technologies in the Treatment of Adult Spinal Deformity
Neurospine. 2021;18(3):417-427.   Published online September 30, 2021
Close
Outcomes for adult spinal deformity continue to improve as new technologies become integrated into clinical practice. Machine learning, robot-guided spinal surgery, and patientspecific rods are tools that are being used to improve preoperative planning and patient satisfaction. Machine learning can be used to predict complications, readmissions, and generate postoperative radiographs which can be shown to patients to guide discussions about surgery. Robot-guided spinal surgery is a rapidly growing field showing signs of greater accuracy in screw placement during surgery. Patient-specific rods offer improved outcomes through higher correction rates and decreased rates of rod breakage while decreasing operative time. The objective of this review is to evaluate trends in the literature about machine learning, robot-guided spinal surgery, and patient-specific rods in the treatment of adult spinal deformity.

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An Application of Artificial Intelligence to Diagnostic Imaging of Spine Disease: Estimating Spinal Alignment From Moiré Images
Neurospine. 2019;16(4):697-702.   Published online December 31, 2019
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An Application of Artificial Intelligence to Diagnostic Imaging of Spine Disease: Estimating Spinal Alignment From Moiré Images
Neurospine. 2019;16(4):697-702.   Published online December 31, 2019
Close
The use of artificial intelligence (AI) as a tool supporting the diagnosis and treatment of spinal diseases is eagerly anticipated. In the field of diagnostic imaging, the possible application of AI includes diagnostic support for diseases requiring highly specialized expertise, such as trauma in children, scoliosis, symptomatic diseases, and spinal cord tumors. Moiré topography, which describes the 3-dimensional surface of the trunk with band patterns, has been used to screen students for scoliosis, but the interpretation of the band patterns can be ambiguous. Thus, we created a scoliosis screening system that estimates spinal alignment, the Cobb angle, and vertebral rotation from moiré images. In our system, a convolutional neural network (CNN) estimates the positions of 12 thoracic and 5 lumbar vertebrae, 17 spinous processes, and the vertebral rotation angle of each vertebra. We used this information to estimate the Cobb angle. The mean absolute error (MAE) of the estimated vertebral positions was 3.6 pixels (~5.4 mm) per person. T1 and L5 had smaller MAEs than the other levels. The MAE per person between the Cobb angle measured by doctors and the estimated Cobb angle was 3.42°. The MAE was 4.38° in normal spines, 3.13° in spines with a slight deformity, and 2.74° in spines with a mild to severe deformity. The MAE of the angle of vertebral rotation was 2.9°±1.4°, and was smaller when the deformity was milder. The proposed method of estimating the Cobb angle and AVR from moiré images using a CNN is expected to enhance the accuracy of scoliosis screening.

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Artificial Intelligence for Adult Spinal Deformity
Neurospine. 2019;16(4):686-694.   Published online December 31, 2019
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Artificial Intelligence for Adult Spinal Deformity
Neurospine. 2019;16(4):686-694.   Published online December 31, 2019
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Adult spinal deformity (ASD) is a complex disease that significantly affects the lives of many patients. Surgical correction has proven to be effective in achieving improvement of spinopelvic parameters as well as improving quality of life (QoL) for these patients. However, given the relatively high complication risk associated with ASD correction, it is of paramount importance to develop robust prognostic tools for predicting risk profile and outcomes. Historically, statistical models such as linear and logistic regression models were used to identify preoperative factors associated with postoperative outcomes. While these tools were useful for looking at simple associations, they represent generalizations across large populations, with little applicability to individual patients. More recently, predictive analytics utilizing artificial intelligence (AI) through machine learning for comprehensive processing of large amounts of data have become available for surgeons to implement. The use of these computational techniques has given surgeons the ability to leverage far more accurate and individualized predictive tools to better inform individual patients regarding predicted outcomes after ASD correction surgery. Applications range from predicting QoL measures to predicting the risk of major complications, hospital readmission, and reoperation rates. In addition, AI has been used to create a novel classification system for ASD patients, which will help surgeons identify distinct patient subpopulations with unique risk-benefit profiles. Overall, these tools will help surgeons tailor their clinical practice to address patients’ individual needs and create an opportunity for personalized medicine within spine surgery.

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