Low Back Pain (LBP) is currently the first cause of disability in the world, with a significant socioeconomic burden. Diagnosis and treatment of LBP often involve a multidisciplinary, individualized approach consisting of several outcome measures and imaging data along with emerging technologies. The increased amount of data generated in this process has led to the development of methods related to artificial intelligence (AI), and to computer-aided diagnosis (CAD) in particular, which aim to assist and improve the diagnosis and treatment of LBP. In this manuscript, we have systematically reviewed the available literature on the use of CAD in the diagnosis and treatment of chronic LBP. A systematic research of PubMed, Scopus, and Web of Science electronic databases was performed. The search strategy was set as the combinations of the following keywords: “Artificial Intelligence”, “Machine Learning”, “Deep Learning”, “Neural Network”, “Computer Aided Diagnosis”, “Low Back Pain”, “Lumbar”, “Intervertebral Disc Degeneration”, “Spine Surgery”, etc. The search returned a total of 1536 articles. After duplication removal and evaluation of the abstracts, 1386 were excluded, whereas 93 papers were excluded after full-text examination, taking the number of eligible articles to 57. The main applications of CAD in LBP included classification and regression. Classification is used to identify or categorize a disease, whereas regression is used to produce a numerical output as a quantitative evaluation of some measure. The best performing systems were developed to diagnose degenerative changes of the spine from imaging data, with average accuracy rates >80%. However, notable outcomes were also reported for CAD tools executing different tasks including analysis of clinical, biomechanical, electrophysiological, and functional imaging data. Further studies are needed to better define the role of CAD in LBP care.

Natural Language Processing (NLP) is a discipline at the intersection between Computer Science (CS), Artificial Intelligence (AI), and Linguistics that leverages unstructured human-interpretable (natural) language text. In recent years, it gained momentum also in health-related applications and research. Although preliminary, studies concerning Low Back Pain (LBP) and other related spine disorders with relevant applications of NLP methodologies have been reported in the literature over the last few years. It motivated us to systematically review the literature comprised of two major public databases, PubMed and Scopus. To do so, we first formulated our research question following the PICO guidelines. Then, we followed a PRISMA-like protocol by performing a search query including terminologies of both technical (e.g., natural language and computational linguistics) and clinical (e.g., lumbar and spine surgery) domains. We collected 221 non-duplicated studies, 16 of which were eligible for our analysis. In this work, we present these studies divided into sub-categories, from both tasks and exploited models’ points of view. Furthermore, we report a detailed description of techniques used to extract and process textual features and the several evaluation metrics used to assess the performance of the NLP models. However, what is clear from our analysis is that additional studies on larger datasets are needed to better define the role of NLP in the care of patients with spinal disorders.

In recent years, the explainable artificial intelligence (XAI) paradigm is gaining wide research interest. The natural language processing (NLP) community is also approaching the shift of paradigm: building a suite of models that provide an explanation of the decision on some main task, without affecting the performances. It is not an easy job for sure, especially when very poorly interpretable models are involved, like the almost ubiquitous (at least in the NLP literature of the last years) transformers. Here, we propose two different transformer-based methodologies exploiting the inner hierarchy of the documents to perform a sentiment analysis task while extracting the most important (with regards to the model decision) sentences to build a summary as the explanation of the output. For the first architecture, we placed two transformers in cascade and leveraged the attention weights of the second one to build the summary. For the other architecture, we employed a single transformer to classify the single sentences in the document and then combine the probability scores of each to perform the classification and then build the summary. We compared the two methodologies by using the IMDB dataset, both in terms of classification and explainability performances. To assess the explainability part, we propose two kinds of metrics, based on benchmarking the models’ summaries with human annotations. We recruited four independent operators to annotate few documents retrieved from the original dataset. Furthermore, we conducted an ablation study to highlight how implementing some strategies leads to important improvements on the explainability performance of the cascade transformers model.