Abstract
Automated assessment of degenerative pathology in the lumbar spine on magnetic resonance imaging (MRI) requires access to large-scale datasets of expert-annotated radiological gradings. In contrast, segmentation pseudo-labels can be generated by automated tools at negligible radiologist cost. We examine whether pre-training on segmentation can effectively replace a fraction of the manual grading annotations required for downstream supervision. We pre-train a 3D ResNet encoder to segment the vertebrae, intervertebral discs (IVDs), and the spinal canal, then fine-tune lightweight task-specific grading heads using different proportions of the available training data, ranging from 10% to 100%. On a multicentre dataset of ∼2,000 subjects across 11 pathologies, segmentation pre-training, achieving a Dice score of 0.94 against pseudo-labels, improved the task-averaged (macro) one-vs-rest ROC-AUC at all proportions. With only 20\% of grading labels after pre-training, the method achieved near full-supervision performance, with the largest gains observed for either low-prevalence or spatially grounded pathologies.