Identification of Anterior Cervical Spinal Instrumentation Using a Smartphone Application Powered by Machine Learning

Spine (Phila Pa 1976). 2022 May 1;47(9):E407-E414. doi: 10.1097/BRS.0000000000004172. Epub 2021 Jul 16.


Study design: Cross-sectional study.

Objective: The purpose of this study is to develop and validate a machine learning algorithm for the automated identification of anterior cervical discectomy and fusion (ACDF) plates from smartphone images of anterior-posterior (AP) cervical spine radiographs.

Summary of background data: Identification of existing instrumentation is a critical step in planning revision surgery for ACDF. Machine learning algorithms that are known to be adept at image classification may be applied to the problem of ACDF plate identification.

Methods: A total of 402 smartphone images containing 15 different types of ACDF plates were gathered. Two hundred seventy-five images (∼70%) were used to train and validate a convolution neural network (CNN) for classification of images from radiographs. One hundred twenty-seven (∼30%) images were held out to test algorithm performance.

Results: The algorithm performed with an overall accuracy of 94.4% and 85.8% for top-3 and top-1 accuracy, respectively. Overall positive predictive value, sensitivity, and f1-scores were 0.873, 0.858, and 0.855, respectively.

Conclusion: This algorithm demonstrates strong performance in the classification of ACDF plates from smartphone images and will be deployed as an accessible smartphone application for further evaluation, improvement, and eventual widespread use.Level of Evidence: 3.

MeSH terms

  • Bone Plates
  • Cervical Vertebrae* / diagnostic imaging
  • Cervical Vertebrae* / surgery
  • Cross-Sectional Studies
  • Diskectomy / methods
  • Humans
  • Machine Learning
  • Retrospective Studies
  • Smartphone
  • Spinal Fusion* / methods
  • Treatment Outcome