• Zheng Liu, Zhihai Su, Min Wang, Tao Chen, Zhifei Cui, Xiaojun Chen, Shaolin Li, Qianjin Feng, Shumao Pang, and Hai Lu.
• Fifth Affiliated Hospital of Sun Yat-sen University, Spinal surgery, Zhuhai, Guangdong, China.
• Pain Physician. 2022 Jan 1; 25 (1): E27-E35.

BackgroundSegmentation of spinal structures is important in medical imaging analysis, which facilitates surgeons to plan a preoperative trajectory for the transforaminal approach. However, manual segmentation of spinal structures is time-consuming, and studies have not explored automatic segmentation of spinal structures at the L5/S1 level.ObjectivesThis study sought to develop a new method based on a deep learning algorithm for automatic segmentation of spinal structures. The resulting algorithm may be used to rapidly generate a precise 3D lumbosacral intervertebral foramen model to assist physicians in planning an ideal trajectory in L5/S1 lumbar transforaminal radiofrequency ablation (LTRFA).Study DesignThis was an observational study for developing a new technique on spinal structures segmentation.Study SiteThe study was carried out at the department of radiology and spine surgery at our hospital.MethodsA total of 100 L5/S1 level data samples from 100 study patients were used in this study. Masks of vertebral bone structures (VBSs) and intervertebral discs (IVDs) for all data samples were segmented manually by a skilled surgeon and served as the "ground truth." After data preprocessing, a 3D-UNet model based on deep learning was used for automated segmentation of lumbar spine structures at L5/S1 level magnetic resonance imaging (MRI). Segmentation performances and morphometric measurement were used for 3D lumbosacral intervertebral foramen (LIVF) reconstruction  generated by either manual segmentation and automatic segmentation.ResultsThe 3D-UNet model showed high performance in automatic segmentation of lumbar spinal structures (VBSs and IVDs). The corresponding mean Dice similarity coefficient (DSC) of 5-fold cross-validation scores for L5 vertebrae, IVDs, S1 vertebrae, and all L5/S1 level spinal structures were 93.46 ± 2.93%, 90.39 ± 6.22%, 93.32 ± 1.51%, and 92.39 ± 2.82%, respectively. Notably, the analysis showed no associated difference in morphometric measurements between the manual and automatic segmentation at the L5/S1 level.LimitationsSemantic segmentation of multiple spinal structures (such as VBSs, IVDs, blood vessels, muscles, and ligaments) was simultaneously not integrated into the deep-learning method in this study. In addition, large clinical experiments are needed to evaluate the clinical efficacy of the model.ConclusionThe 3D-UNet model developed in this study based on deep learning can effectively and simultaneously segment VBSs and IVDs at L5/S1 level formMR images, thereby enabling rapid and accurate 3D reconstruction of LIVF models. The method can be used to segment VBSs and IVDs of spinal structures on MR images within near-human expert performance; therefore, it is reliable for reconstructing LIVF for L5/S1 LTRFA.

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