NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia.
NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia.
World Neurosurg. 2021 Apr;148:e1-e9. doi: 10.1016/j.wneu.2020.11.024. Epub 2020 Nov 12.
Lower back pain associated with degenerative disc disease (DDD) is a leading cause of disability worldwide. Anterior lumbar interbody fusion (ALIF) has been shown to be effective for treating refractory DDD, but it remains unclear which patients may benefit most from the procedure. This study aims to develop a predictive model for clinical success in L5/S1 ALIF for DDD.
A retrospective cohort study of 68 patients with refractory DDD who underwent L5/S1 ALIF was performed. Clinical success was defined as an improvement in Oswestry Disability Index (ODI) of 20 points postoperatively. Exploratory analyses were performed on 16 preoperative clinical and radiographic parameters, followed by a multivariate logistic regression. Evaluation of the predictive model was performed.
After exploratory analyses, 4 parameters were suitable for inclusion in the multivariate model. Workers' compensation status (odds ratio [OR], 0.02; 95% confidence interval [CI], 0.001-0.262; P = 0.004) and preoperative ODI (OR, 1.13; 95% CI, 1.05-1.23; P = 0.002) were statistically significant parameters. Furthermore, posterior disc height and disc depth contributed significantly to the model variance (OR, 0.69, 95% CI, 0.44-1.09 and OR, 0.97, 95% CI, 0.81-1.15, respectively). The model had a sensitivity of 81.5%, specificity of 83.3%, C-statistic of 0.921, and a calibration plot similar to the 45° reference line.
This analysis confirms workers' compensation and low preoperative ODI as risk factors for successful L5/S1 ALIF performed for DDD. It also identifies novel prognostic factors, namely posterior disc height and disc depth. This model can aid in patient counseling and selection in the management of L5/S1 DDD.
与退行性椎间盘疾病（DDD）相关的下腰痛是全球致残的主要原因。前路腰椎体间融合术（ALIF）已被证明对治疗难治性 DDD 有效，但仍不清楚哪些患者可能从该手术中获益最大。本研究旨在为 DDD 的 L5/S1 ALIF 建立临床成功的预测模型。
对 68 例接受 L5/S1 ALIF 治疗的难治性 DDD 患者进行回顾性队列研究。术后 Oswestry 功能障碍指数（ODI）改善 20 分为临床成功。对 16 项术前临床和影像学参数进行探索性分析，然后进行多变量逻辑回归。评估预测模型。
经过探索性分析，有 4 个参数适合纳入多变量模型。工人赔偿状况（比值比 [OR]，0.02；95%置信区间 [CI]，0.001-0.262；P=0.004）和术前 ODI（OR，1.13；95%CI，1.05-1.23；P=0.002）是统计学上显著的参数。此外，后椎间盘高度和椎间盘深度对模型方差有显著贡献（OR，0.69，95%CI，0.44-1.09 和 OR，0.97，95%CI，0.81-1.15）。该模型的敏感性为 81.5%，特异性为 83.3%，C 统计量为 0.921，校准图与 45°参考线相似。
本分析证实工人赔偿和术前 ODI 低是 L5/S1 ALIF 治疗 DDD 成功的危险因素。它还确定了新的预后因素，即后椎间盘高度和椎间盘深度。该模型可辅助 L5/S1 DDD 管理中的患者咨询和选择。
