As one of fundamental ways to interpret spine images, detection of vertebral landmarks is an informative prerequisite for further diagnosis and management of spine disorders such as scoliosis and fractures. Most existing machine learning-based methods for automatic vertebral landmark detection suffer from overlapping landmarks or abnormally long distances between nearby landmarks against anatomical priors, and thus lack sufficient reliability and interpretability. To tackle the problem, this paper systematically utilizes anatomical prior knowledge in vertebral landmark detection. We explicitly formulate anatomical priors of the spine, related to distances among vertebrae and spatial order within the spine, and integrate these geometrical constraints within training loss, inference procedure, and evaluation metrics. First, we introduce an anatomy-constraint loss to regularize the training process with the aforementioned contextual priors explicitly. Second, we propose a simple-yet-effective anatomy-aided inference procedure by employing sequential prediction rather than a parallel counterpart. Third, we provide novel anatomy-related metrics to quantitatively evaluate to which extent landmark predictions follow the anatomical priors, as is not reflected within the widely-used landmark localization error metric. We employ the localization framework on 1410 anterior–posterior radiographic images. Compared with competitive baseline models, we achieve superior landmark localization accuracy and comparable Cobb angle estimation for scoliosis assessment. Ablation studies demonstrate the effectiveness of designed components on the decrease of localization error and improvement of anatomical plausibility. Additionally, we exhibit effective generalization performance by transferring our detection method onto sagittal 2-D slices of CT scans and boost the performance of downstream compression fracture classification at vertebra-level.
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