Background <p>To develop and validate a model that integrates clinical data, deep learning radiomics, and radiomic features to predict high-risk patients for cage subsidence (CS) after lumbar fusion.</p> Methods <p>This study analyzed preoperative CT and MRI data from 305 patients undergoing lumbar fusion surgery from three centers. Using a deep learning model based on 3D vision transformations, the data were divided the dataset into training (<i>n</i> = 214), validation (<i>n</i> = 61), and test (<i>n</i> = 30) groups. Feature selection was performed using LASSO regression, followed by the development of a logistic regression model. The predictive ability of the model was assessed using various machine learning algorithms, and a combined clinical model was also established.</p> Results <p>Ultimately, 11 traditional radiomic features, 5 deep learning radiomic features, and 1 clinical feature were selected. The combined model demonstrated strong predictive performance, with area under the curve (AUC) values of 0.941, 0.832, and 0.935 for the training, validation, and test groups, respectively. Notably, our model outperformed predictions made by two experienced surgeons.</p> Conclusions <p>This study developed a robust predictive model that integrates clinical features and imaging data to identify high-risk patients for CS following lumbar fusion. This model has the potential to improve clinical decision-making and reduce the need for revision surgeries, easing the burden on healthcare systems.</p>