Dense Representation Learning and Differentiable Shape Modeling for Spine Landmark Detection

Spine landmark detection from spinal X-ray is a key step for estimating spine deformation severity, for building biomechanical models, and for pre-operative planning. We reframe anatomical landmark detection as a pixel-level contrastive representation learning problem, matching dense pixel embeddings with landmark prototypes. Surprisingly, even with a generic U-Net backbone, this formulation results in more discriminative heatmaps compared to the traditional heatmap regression paradigm, leading to improved discrimination between vertebral corners on distinct vertebra. Furthermore, we combine the resulting heatmaps with learnable shape priors over the global configuration of spinal landmarks to resolve ambiguities in landmark locations, yielding a simple and practical approach to spinal landmark detection. Our approach is competitive, in terms of landmark accuracy and clinical parameter estimation, with the state-of-the-art on the public AASCE dataset and on two private spinal X-ray datasets. Our code and pre-trained weights are available at https://github.com/BioMedTP/Pix2Point.