Transformer-Based Deep Learning for Multiplanar Cervical Spine MRI Interpretation: Comparison with Spine Surgeons and Radiologists

Background: Degenerative cervical spondylosis (DCS) is a common and potentially debilitating condition, with surgery indicated in selected patients. Deep learning models (DLMs) can improve consistency in grading DCS neural stenosis on magnetic resonance imaging (MRI), though existing models focus on axial images, and comparisons are mostly limited to radiologists. Methods: We developed an enhanced transformer-based DLM that trains on sagittal images and optimizes axial and foraminal classification using a maximized dataset. DLM training utilized 648 scans, with internal testing on 75 scans and external testing on an independent 75-scan dataset. Performance of the DLM, spine surgeons, and radiologists of varying subspecialities/seniority were compared against a consensus reference standard. Results: On internal testing, the DLM achieved high agreement for all-class classification: axial spinal canal κ = 0.80 (95%CI: 0.72–0.82), sagittal spinal canal κ = 0.83 (95%CI: 0.81–0.85), and neural foramina κ = 0.81 (95%CI: 0.77–0.84). In comparison, human readers demonstrated lower levels of agreement (κ = 0.60–0.80). External testing showed modestly degraded model performance (κ = 0.68–0.77). Conclusions: These results demonstrate the utility of transformer-based DLMs in multiplanar MRI interpretation, surpassing spine surgeons and radiologists on internal testing and highlighting its potential for real-world clinical adoption.