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Glaser et al. Art Int Surg. 2025;5:1-15  https://dx.doi.org/10.20517/ais.2024.36                                                                                                     Page 7





                                                                                                                                 (reference        variability    analysis, etc.)
                                                                                                                                 standard)                        against manual
                                                                                                                                                                  measurements
                          Kim et al.  1,807 lateral        X-ray    Mask R-CNN      0.4°-3.0°   NA           Mean absolute error  Compared to      Did not include  200 test images;   Mask R-CNN   18     36 epochs
                               [24]
                          2023       radiographs; variety of        for vertebral                            vs. manual          measurements by  images with     statistical analysis  (ResNet 101   images
                                     spinal conditions              segmentation                             measurements:       3 surgeons        severe spinal   (MAE, ICC, etc.)   backbone)    per
                                                                                                             0.4°-3.0° for       (criterion        deformities or   against manual                 batch
                                                                                                             parameters; dice    standard)         implants       measurements
                                                                                                             similarity coefficient:
                                                                                                             92.6% for
                                                                                                             segmentation

                          Yeh et al.  2,210 whole spine    X-ray    Cascaded        Landmark:  NA            Median error: 1.75-  Compared to      Single center   400 test images;   Cascaded     NA      120 epochs
                               [25]
                          2021       lateral radiographs;           pyramid         1.75-3.39                3.39 mm for         measurements by  data; did not   statistical analysis  pyramid net        (early
                                     variety of spinal              network +       mm;                      landmarks;          3 doctors (ground  include images   against ground                        stopping
                                     conditions                     differentiable   parameter:              parameter errors:   truth)            with vertebral   truth                                  applied)
                                                                    spatial to      0.1°-6.6°                mean 0.1°-6.6°,                       anomalies      measurements
                                                                    numerical                                median 0.03-5.3°
                                                                    transform layer
                          Orosz et   600 lateral spine     X-ray    CNN for         Not         0.75-0.92    Intraclass correlation  Compared to   Single-center   Statistical analysis  Convolutional  NA  NA
                                 [26]
                          al. 2022   radiographs for                segmentation +  reported                 coefficient between  measurements by  data for       (ICC, mean error,  NN + U-Net
                                     training; 200 lumbar           U-Net for                                AI and human raters:  expert human    validation; did   etc.) against
                                     spine radiographs (100         landmark                                 0.85-0.92 pre-op,   raters            not assess intra- manual
                                     pre-op, 100 post-op)           detection                                0.75-0.91 post-op                     rater reliability  measurements by
                                     for testing                                                                                                                  expert raters
                          Gami et al.  100 images to train   X-ray  YOLO version 3  Cobb:       NA           Average absolute    Compared to       Testing only on  Cadaver testing +  YOLOv3 CNN NA       NA
                               [27]
                          2022       model, 130 images to           CNN             1.726°                   difference - Cobb   radiographic      single cadaver   verification testing
                                     test model                                                              angle: 1.726°, plumb  measurements in  model and     on artificial
                                                                                                             line: 0.415 cm      cadaver model     artificial     templates
                                                                                                                                                   templates
                          Schwartz   816 lateral lumbar    X-ray    MultiResUNet    ≤ 4.6°      NA           Mean absolute       Compared to       10% failure rate  163 test images;   MultiResUNet NA    NA
                          et al.     radiographs including          CNN +                                    difference vs.      measurements by  for Cobb angle;  statistical analysis
                               [28]
                          2021       some with                      computer vision                          surgeons: ≤ 4.6° for  3 orthopedic spine  potential for   against manual
                                     instrumentation/hip            pipeline                                 parameters; success  surgeons         measurement    surgeon
                                     prostheses                                                              rate: 90%-100%                        skew           measurements
                          Aubert et  68 biplanar           X-ray    CNN for         Landmark:  NA            Mean error: 1.6-2.3   Compared to     Small dataset   Comparison to    CNNs           NA      NA
                                 [29]
                          al. 2019   radiographs with               anatomical      1.6-2.3 mm;              mm for landmarks;   expert supervised  from single   multiple expert
                                     variety of spinal              landmark        parameter:               2.8°-4.7° for spinal   reconstructions   center      supervised
                                     conditions                     detection to fit   2.8°-4.7°             parameters; 1°-2.1°   (ground truth)                 reconstructions;
                                                                    statistical spine                        for pelvic                                           automated vs.
                                                                    model                                    parameters                                           expert agreement
                                                                                                                                                                  analysis

                          Nguyen et  500 whole spine lateral  X-ray  Decentralized   1.156°-    ≥ 0.8 for 10 of  Correlation     Compared to       Difficulty with   30 test images +   VGG-net    Batch   50 epochs
                                 [30]
                          al. 2022   radiographs with               CNN             6.318°      12 parameters  coefficient: ≥ 0.8 for  manual      parameters     statistical analysis  based CNN   size: 32
                                     variety of conditions                                                   10 of 12 parameters;  measurements by  related to T1   against standard   architecture
                                                                                                             mean absolute error:  experienced     vertebrae;     reference
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