An Artificial Intelligence-Based Support Tool for Lumbar Spinal Stenosis Diagnosis from Self-Reported History Questionnaire.

OBJECTIVES: Symptomatic lumbar spinal stenosis (LSS) leads to functional impairment and pain. While radiologic characterization of the morphological stenosis grade can aid in the diagnosis, it may not always correlate with patient symptoms. Artificial intelligence (AI) may diagnose symptomatic LSS in patients solely based on self-reported history questionnaires. METHODS: We evaluated multiple machine learning (ML) models to determine the likelihood of LSS using a self-reported questionnaire in patients experiencing low back pain and/or numbness in the legs. The questionnaire was built from peer-reviewed literature and a multidisciplinary panel of experts. Random forest, lasso logistic regression, support vector machine, gradient boosting trees, deep neural networks, and automated machine learning models were trained and performance metrics were compared. RESULTS: Data from 4827 patients (4690 patients without LSS: mean age 62.44, range 27-84 years, 62.8% females, and 137 patients with LSS: mean age 50.59, range 30-71 years, 59.9% females) were retrospectively collected. Among the evaluated models, the random forest model demonstrated the highest predictive accuracy with an area under the receiver operating characteristic curve (AUROC) between model prediction and LSS diagnosis of 0.96, a sensitivity of 0.94, a specificity of 0.88, a balanced accuracy of 0.91, and a Cohen's kappa of 0.85. CONCLUSIONS: Our results indicate that ML can automate the diagnosis of LSS based on self-reported questionnaires with high accuracy. Implementation of standardized and intelligence-automated workflow may serve as a supportive diagnostic tool to streamline patient management and potentially lower health care costs.

A neural network model for detection and classification of lumbar spinal stenosis on MRI.

OBJECTIVES: To develop a three-stage convolutional neural network (CNN) approach to segment anatomical structures, classify the presence of lumbar spinal stenosis (LSS) for all 3 stenosis types: central, lateral recess and foraminal and assess its severity on spine MRI and to demonstrate its efficacy as an accurate and consistent diagnostic tool. METHODS: The three-stage model was trained on 1635 annotated lumbar spine MRI studies consisting of T2-weighted sagittal and axial planes at each vertebral level. Accuracy of the model was evaluated on an external validation set of 150 MRI studies graded on a scale of absent, mild, moderate or severe by a panel of 7 radiologists. The reference standard for all types was determined by majority voting and in case of disagreement, adjudicated by an external radiologist. The radiologists' diagnoses were then compared to the diagnoses of the model. RESULTS: The model showed comparable performance to the radiologist average both in terms of the determination of presence/absence of LSS as well as severity classification, for all 3 stenosis types. In the case of central canal stenosis, the sensitivity, specificity and AUROC of the CNN were (0.971, 0.864, 0.963) for binary (presence/absence) classification compared to the radiologist average of (0.786, 0.899, 0.842). For lateral recess stenosis, the sensitivity, specificity and AUROC of the CNN were (0.853, 0.787, 0.907) compared to the radiologist average of (0.713, 0.898, 805). For foraminal stenosis, the sensitivity, specificity and AUROC of the CNN were (0.942, 0.844, 0.950) compared to the radiologist average of (0.879, 0.877, 0.878). Multi-class severity classifications showed similarly comparable statistics. CONCLUSIONS: The CNN showed comparable performance to radiologist subspecialists for the detection and classification of LSS. The integration of neural network models in the detection of LSS could bring higher accuracy, efficiency, consistency, and post-hoc interpretability in diagnostic practices.

Determining Prior Authorization Approval for Lumbar Stenosis Surgery With Machine Learning.

STUDY DESIGN: Medical vignettes. OBJECTIVES: Lumbar spinal stenosis (LSS) is a degenerative condition with a high prevalence in the elderly population, that is associated with a significant economic burden and often requires spinal surgery. Prior authorization of surgical candidates is required before patients can be covered by a health plan and must be approved by medical directors (MDs), which is often subjective and clinician specific. In this study, we hypothesized that the prediction accuracy of machine learning (ML) methods regarding surgical candidates is comparable to that of a panel of MDs. METHODS: Based on patient demographic factors, previous therapeutic history, symptoms and physical examinations and imaging findings, we propose an ML which computes the probability of spinal surgical recommendations for LSS. The model implements a random forest model trained from medical vignette data reviewed by MDs. Sets of 400 and 100 medical vignettes reviewed by MDs were used for training and testing. RESULTS: The predictive accuracy of the machine learning model was with a root mean square error (RMSE) between model predictions and ground truth of .1123, while the average RMSE between individual MD's recommendations and ground truth was .2661. For binary classification, the AUROC and Cohen's kappa were .959 and .801, while the corresponding average metrics based on individual MD's recommendations were .844 and .564, respectively. CONCLUSIONS: Our results suggest that ML can be used to automate prior authorization approval of surgery for LSS with performance comparable to a panel of MDs.

Performance of hybrid artificial intelligence in determining candidacy for lumbar stenosis surgery.

PURPOSE: Lumbar spinal stenosis (LSS) is a condition affecting several hundreds of thousands of adults in the United States each year and is associated with significant economic burden. The current decision-making practice to determine surgical candidacy for LSS is often subjective and clinician specific. In this study, we hypothesize that the performance of artificial intelligence (AI) methods could prove comparable in terms of prediction accuracy to that of a panel of spine experts. METHODS: We propose a novel hybrid AI model which computes the probability of spinal surgical recommendations for LSS, based on patient demographic factors, clinical symptom manifestations, and MRI findings. The hybrid model combines a random forest model trained from medical vignette data reviewed by surgeons, with an expert Bayesian network model built from peer-reviewed literature and the expert opinions of a multidisciplinary team in spinal surgery, rehabilitation medicine, interventional and diagnostic radiology. Sets of 400 and 100 medical vignettes reviewed by surgeons were used for training and testing. RESULTS: The model demonstrated high predictive accuracy, with a root mean square error (RMSE) between model predictions and ground truth of 0.0964, while the average RMSE between individual doctor's recommendations and ground truth was 0.1940. For dichotomous classification, the AUROC and Cohen's kappa were 0.9266 and 0.6298, while the corresponding average metrics based on individual doctor's recommendations were 0.8412 and 0.5659, respectively. CONCLUSIONS: Our results suggest that AI can be used to automate the evaluation of surgical candidacy for LSS with performance comparable to a multidisciplinary panel of physicians.