Application of Artificial Intelligence and Machine Learning for the Prediction of Interbody Cage Height and Postoperative Alignment in Transforaminal Lumbar Interbody Fusion

Abstract

Transforaminal lumbar interbody fusion (TLIF) is a commonly used technique for treating lumbar degenerative diseases. Here, we developed a fully computer-supported pipeline to predict the cage height and the degree of lumbar lordosis subtraction from the pelvic incidence (PI-LL) after TLIF surgery through preoperative X-ray images. The automated pipeline included two primary stages. First, a deep learning model was used to extract essential features from X-ray images. Second, five machine learning algorithms were trained to identify the optimal models to predict the interbody cage height and postoperative PI-LL. Lasso regression and support vector regression exhibited superior performance for predicting the interbody cage height and postoperative PI-LL, respectively. For cage height prediction, the root mean square error (RMSE) was calculated as 1.01, and the model achieved the highest accuracy at a height of 12 mm, with exact prediction achieved in 54.43% (43/79) of cases. In most of the remaining cases, the prediction error of the model was within 1 mm. In addition, the model demonstrated adequate performance for predicting PI-LL, with an RMSE of 5.19 and an accuracy of 0.81 for PI-LL stratification. In conclusion, the interbody cage height and postoperative PI-LL can be reliably predicted using artificial intelligence and ML models.