Comparatively, ANNs have been tested against gold-standard diagnostic categorization of low back pain in patients. The results revealed a high sensitivity and specificity of 95.7% and 100%, respectively. The successful combination of these ML algorithms with additional diagnostic tests could potentially revolutionize the clinician’s diagnostic process
[23].
3. AI and ML in Spinal Imaging
Spinal imaging is a cornerstone of the diagnosis and management of various spinal disorders. Traditionally, these images have been analyzed manually by clinicians—a process that can be time-consuming and susceptible to human error. However, the advent of AI and ML has transformed this situation, enabling automated, fast, and precise image interpretation.
One of the fundamental applications of AI in spinal care revolves around localization—a concept associated with object detection and classification
[24][25][26][27][28]. This concept enables the identification and labeling of an object in an image and can be invaluable in detecting anomalies in the spine. The SVM represents one such ML model that has demonstrated effectiveness in this field. SVMs have been used in detecting incidental lumbar spine fractures on X-rays, predicting forces applied to the lower back during weighted loading, and even characterizing type 1 Gaucher disease based on bone microarchitecture
[29][30].
Similarly, the random-forest model, another ML technique, has been employed to identify osteoporosis more effectively than traditional bone turnover markers alone. It has also been used in the screening of patients undergoing non-osteoporosis dedicated CT imaging for potential osteoporosis
[31].
Neural networks have found use in predicting fractures, both of the spine and the hip. Notably, these networks have been trained to detect posterior-element spinal fractures in trauma patients using CT images. Further, they have been used to identify hip fractures using a combination of radiographs, patient traits, and hospital process variables. In an exciting development, researchers found that image recognition algorithms using both imaging and non-imaging data may primarily use non-imaging data
[32].
Convoluted neural networks (CNNs)—an offshoot of neural networks—have been developed to characterize and classify alignment-related pathologies, such as kyphosis and scoliosis
[33][34]. One such CNN generated by Jamaludin et al. from dual-energy X-ray absorptiometry (DEXA) scans was able to automate spine curve identification, boasting a sensitivity of 86.5%, a specificity of 96.9%, and an AUC (area under the ROC curve) of 0.80
[35]. This capability opens the possibility for earlier detection of alignment-related pathologies, such as scoliosis and kyphosis.
Regression techniques have also been incorporated in ML for spinal care, with logistic regression models predicting the development of neuromuscular scoliosis in pediatric patients with cerebral palsy. Linear regression models have been used for postoperative height gain following the correction of idiopathic scoliosis
[36].
Clustering methods have been used to identify distinct subgroups within adolescent idiopathic scoliosis populations. However, it has been challenging to identify discriminatory characteristics for patient clustering in certain study sets
[34].
AI has also been beneficial in diagnosing various types of spinal pathologies, including lumbar neural foraminal stenosis and central spinal stenosis
[12][36][37][38]. Deep neural networks have been employed to automatically localize and grade multiple spinal regions. These ML methods have the potential to reduce the qualitative MRI grading time in large epidemiological studies. Similarly, deep neural networks have been utilized to automatically localize and grade multiple spinal regions to diagnose conditions such as lumbar neural foraminal stenosis
[36][38][39].
In another study, Roller et al. applied CNNs to MRI images to predict the operative level of patients undergoing disc decompression surgery
[28]. An algorithm has also been developed to predict patients at risk for re-herniation after microdiscectomy, achieving a recall of 0.80 and an accuracy of 0.70
[28].
AI has even been used to predict early-onset adjacent segment degeneration following anterior cervical discectomy fusion (ACDF) using an SVM on tabular data
[40].
Overall, AI and ML techniques in spinal imaging have shown promising results in improving the accuracy, speed, and predictive capability of the diagnosis and treatment of spinal conditions. These developments hold great promise for improving patient outcomes and transforming the way spinal care is delivered. However, it is essential to continue to refine these AI and ML models, incorporating new insights and additional patient features to ensure their continued evolution and relevance in clinical practice.
4. Role of AI and ML in Spinal Rehabilitation
AI and ML have diverse applications in rehabilitation, including applications in the field of physical medicine and rehabilitation (PM&R). In rehabilitation, ML is utilized in various areas, including symbiotic neuroprosthetics, myoelectric control, brain–computer interfaces, perioperative medicine, musculoskeletal medicine, diagnostic imaging, patient data measurement, and clinical decision support [41][42][43]. AI has even been used to assess rehabilitative exercises based on machine indications [41][42][43][44]. Brain–computer interfaces (BCIs) have emerged as a novel approach in neurorehabilitation. By recording and decoding brain signals, BCIs aim to enhance motor imagery-based training, facilitate task execution through functional electrical stimulation or robotic orthoses, and understand cerebral reorganizations after injury. BCIs show potential in promoting recovery and can be adapted to a diverse population. However, controlled clinical trials are needed to validate their effectiveness in pathological conditions and compare them to traditional methods [41][42].
5. Ensuring Accuracy in AI-Driven Diagnosis and Treatment
AI and ML models are as good as the data they are trained on. Thus, the quality and diversity of the data used play a significant role in the validity of the AI model. If the training data are not representative of the broader population or the specific patient groups, the AI model may perform poorly when deployed in real-world settings. Therefore, using high-quality, diverse, and representative datasets during model training is essential for ensuring the validity of AI models
[45].
The reliability of an AI system refers to its ability to consistently produce the same results under the same conditions. This is particularly important in healthcare settings where reliable predictions are crucial for clinical decision making. Variability in AI system performance can lead to different diagnoses or treatment plans for the same patient, which can have serious implications for patient care
[46]. Ensuring the validity and reliability of AI systems in spinal care also involves external validation, where the performance of AI models is assessed using data that were not involved in the model’s training or initial validation. This is a crucial step to gauge the generalizability of AI models and their readiness for real-world clinical deployment
[47].
Lastly, a system for continuous monitoring and evaluation should be in place. This allows for the detection of any changes in the performance of AI models over time, providing an opportunity to make necessary adjustments and updates
[48].
In conclusion, the integration of AI and ML into spinal care promises many benefits, but it is incumbent upon us to ensure the accuracy and reliability of these AI-driven systems.