A novel artificial Intelligence-Based model for automated Lenke classification in adolescent idiopathic scoliosis.

Purpose: To develop an artificial intelligence (AI)-driven model for automatic Lenke classification of adolescent idiopathic scoliosis (AIS) and assess its performance.

Methods: This retrospective study utilized 860 spinal radiographs from 215 AIS patients with four views, including 161 training sets and 54 testing sets. Additionally, 1220 spinal radiographs from 610 patients with only anterior-posterior (AP) and lateral (LAT) views were collected for training. The model was designed to perform keypoint detection, pedicle segmentation, and AIS classification based on a custom classification strategy. Its performance was evaluated against the gold standard using metrics such as mean absolute difference (MAD), intraclass correlation coefficient (ICC), Bland-Altman plots, Cohen's Kappa, and the confusion matrix.

Results: In comparison to the gold standard, the MAD for all predicted angles was 2.29°, with an excellent ICC. Bland-Altman analysis revealed minimal differences between the methods. For Lenke classification, the model exhibited exceptional consistency in curve type, lumbar modifier, and thoracic sagittal profile, with average Kappa values of 0.866, 0.845, and 0.827, respectively, and corresponding accuracy rates of 87.07%, 92.59%, and 92.59%. Subgroup analysis further confirmed the model's high consistency, with Kappa values ranging from 0.635 to 0.930, 0.672 to 0.926, and 0.815 to 0.847, and accuracy rates between 90.7 and 98.1%, 92.6-98.3%, and 92.6-98.1%, respectively.

Conclusion: This novel AI system facilitates the rapid and accurate automatic Lenke classification, offering potential assistance to spinal surgeons.