• Bayard Wilson, Bilwaj Gaonkar, Bryan Yoo, Banafsheh Salehi, Mark Attiah, Diane Villaroman, Christine Ahn, Matthew Edwards, Azim Laiwalla, Anshul Ratnaparkhi, Ien Li, Kirstin Cook, Joel Beckett, and Luke Macyszyn.
• Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.
• Neurosurgery. 2021 Jun 15; 89 (1): 116-121.

BackgroundThe referral process for consultation with a spine surgeon remains inefficient, given a substantial proportion of referrals to spine surgeons are nonoperative.ObjectiveTo develop a machine-learning-based algorithm which accurately identifies patients as candidates for consultation with a spine surgeon, using only magnetic resonance imaging (MRI).MethodsWe trained a deep U-Net machine learning model to delineate spinal canals on axial slices of 100 normal lumbar MRI scans which were previously delineated by expert radiologists and neurosurgeons. We then tested the model against lumbar MRI scans for 140 patients who had undergone lumbar spine MRI at our institution (60 of whom ultimately underwent surgery, and 80 of whom did not). The model generated automated segmentations of the lumbar spinal canals and calculated a maximum degree of spinal stenosis for each patient, which served as our biomarker for surgical pathology warranting expert consultation.ResultsThe machine learning model correctly predicted surgical candidacy (ie, whether patients ultimately underwent lumbar spinal decompression) with high accuracy (area under the curve = 0.88), using only imaging data from lumbar MRI scans.ConclusionAutomated interpretation of lumbar MRI scans was sufficient to correctly determine surgical candidacy in nearly 90% of cases. Given that a significant proportion of referrals placed for spine surgery evaluation fail to meet criteria for surgical intervention, our model could serve as a valuable tool for patient triage and thereby address some of the inefficiencies within the outpatient surgical referral process.© Congress of Neurological Surgeons 2021.

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