Abstract
Background: Lumbar spondylolisthesis (LS) is a common spinal disorder characterized by the forward displacement of the vertebra. Early detection is challenging due to asymptomatic presentation in the early stages. This study develops and validates an AI-based deep learning model for the early, high-precision diagnosis of LS using lumbar X-ray images. Methods: A total of 3300 lateral lumbar X-ray images were collected from Beijing Tongren Hospital, and an external dataset of 1100 images was used for validation. The images were randomly divided into the training, validation, and test sets. The model uses semantic segmentation to precisely segment vertebral bodies and calculate distances between vertebrae to identify and grade LS using the Meyerding classification. Model performance was compared to other algorithms and clinical experts. Results: The model achieved F1 Scores of 0.92 and 0.91 on the hospital and external datasets, respectively, outperforming other methods. It showed diagnostic accuracies of 96.1% and 94.4%, exceeding the performance of physicians (90.6% and 89.3%). These results highlight the potential of AI in improving diagnostic accuracy and clinical decision-making. Conclusions: Our deep learning model demonstrates high accuracy and reliability in diagnosing LS, providing a valuable tool for early detection and better patient outcomes. Future work will involve expanding the dataset and validating the model in clinical settings.