Cargando…
Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors
PURPOSE: To investigate the preoperative radiological risk factors for recurrent lumbar disc herniation (rLDH) within 1 year after percutaneous endoscopic transforaminal discectomy (PETD). PATIENTS AND METHODS: A retrospective case–control study was conducted. Between January 2013 and November 2019,...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277456/ https://www.ncbi.nlm.nih.gov/pubmed/34276226 http://dx.doi.org/10.2147/JPR.S312224 |
_version_ | 1783722078597283840 |
---|---|
author | Zhao, Chong Zhang, Hao Wang, Yan Xu, Derong Han, Shuo Meng, Shengwei Han, Jialuo Liu, Houchen Zhou, Chuanli Ma, Xuexiao |
author_facet | Zhao, Chong Zhang, Hao Wang, Yan Xu, Derong Han, Shuo Meng, Shengwei Han, Jialuo Liu, Houchen Zhou, Chuanli Ma, Xuexiao |
author_sort | Zhao, Chong |
collection | PubMed |
description | PURPOSE: To investigate the preoperative radiological risk factors for recurrent lumbar disc herniation (rLDH) within 1 year after percutaneous endoscopic transforaminal discectomy (PETD). PATIENTS AND METHODS: A retrospective case–control study was conducted. Between January 2013 and November 2019, a total of 1210 patients with single-level L4/5 LDH who underwent PETD were enrolled in the present study. In total, 62 rLDH patients were diagnosed and collected based on the clinical and radiological manifestations, and 224 non-rLDH controls were selected from the remaining 1148 patients. Preoperative radiological parameters were collected and measured. An age threshold to distinguish patients into subgroups was established using the Youden index. The relationships between the risk factors and rLDH were evaluated by univariate and multivariate analyses in two subgroups. Predictive models were established based on logistic analysis. The area under the curve (AUC) of receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were used to assess the predictive models. RESULTS: In the present study, logistic analysis identified six significant predictors associated with rLDH in the young group: superior endplate concave angle (ECA), sacral slope, Modic changes, sagittal range of motion (sROM), extension intervertebral angle (IVA), and lumbar lordosis. Four significant predictors were identified in the elderly group: disc height index (DHI), retrolisthesis (posterior spondylolisthesis), sROM, and extension IVA. Validation of both models demonstrated excellent model discrimination (AUC= 0.940 and 0.946, respectively). DCA also showed excellent clinical utility and benefits. CONCLUSION: The nomograms that we constructed could accurately predict individual patient recurrence risk. Individualized measures should be taken for patients of different ages with the above risk factors, and tailored postoperative surveillance of patients who underwent PETD can be planned. |
format | Online Article Text |
id | pubmed-8277456 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-82774562021-07-15 Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors Zhao, Chong Zhang, Hao Wang, Yan Xu, Derong Han, Shuo Meng, Shengwei Han, Jialuo Liu, Houchen Zhou, Chuanli Ma, Xuexiao J Pain Res Original Research PURPOSE: To investigate the preoperative radiological risk factors for recurrent lumbar disc herniation (rLDH) within 1 year after percutaneous endoscopic transforaminal discectomy (PETD). PATIENTS AND METHODS: A retrospective case–control study was conducted. Between January 2013 and November 2019, a total of 1210 patients with single-level L4/5 LDH who underwent PETD were enrolled in the present study. In total, 62 rLDH patients were diagnosed and collected based on the clinical and radiological manifestations, and 224 non-rLDH controls were selected from the remaining 1148 patients. Preoperative radiological parameters were collected and measured. An age threshold to distinguish patients into subgroups was established using the Youden index. The relationships between the risk factors and rLDH were evaluated by univariate and multivariate analyses in two subgroups. Predictive models were established based on logistic analysis. The area under the curve (AUC) of receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were used to assess the predictive models. RESULTS: In the present study, logistic analysis identified six significant predictors associated with rLDH in the young group: superior endplate concave angle (ECA), sacral slope, Modic changes, sagittal range of motion (sROM), extension intervertebral angle (IVA), and lumbar lordosis. Four significant predictors were identified in the elderly group: disc height index (DHI), retrolisthesis (posterior spondylolisthesis), sROM, and extension IVA. Validation of both models demonstrated excellent model discrimination (AUC= 0.940 and 0.946, respectively). DCA also showed excellent clinical utility and benefits. CONCLUSION: The nomograms that we constructed could accurately predict individual patient recurrence risk. Individualized measures should be taken for patients of different ages with the above risk factors, and tailored postoperative surveillance of patients who underwent PETD can be planned. Dove 2021-07-09 /pmc/articles/PMC8277456/ /pubmed/34276226 http://dx.doi.org/10.2147/JPR.S312224 Text en © 2021 Zhao et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Zhao, Chong Zhang, Hao Wang, Yan Xu, Derong Han, Shuo Meng, Shengwei Han, Jialuo Liu, Houchen Zhou, Chuanli Ma, Xuexiao Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors |
title | Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors |
title_full | Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors |
title_fullStr | Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors |
title_full_unstemmed | Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors |
title_short | Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors |
title_sort | nomograms for predicting recurrent herniation in petd with preoperative radiological factors |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277456/ https://www.ncbi.nlm.nih.gov/pubmed/34276226 http://dx.doi.org/10.2147/JPR.S312224 |
work_keys_str_mv | AT zhaochong nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors AT zhanghao nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors AT wangyan nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors AT xuderong nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors AT hanshuo nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors AT mengshengwei nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors AT hanjialuo nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors AT liuhouchen nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors AT zhouchuanli nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors AT maxuexiao nomogramsforpredictingrecurrentherniationinpetdwithpreoperativeradiologicalfactors |