Departments of Spine Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.
Nursing Platform of Spinal Surgery Department, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China.
Orthop Surg. 2021 Apr;13(2):484-492. doi: 10.1111/os.12861. Epub 2021 Feb 7.
This study aimed to build a predictive model of lower lumbar instability.
This retrospective study included 199 patients. Patients were divided into the lower lumbar instability group (LLIG) (n = 98) and lower lumbar stability group (LLSG) (n = 101). All participants of LLIG were recruited over a 2-year period (2015-2017) from the patients who accept lumbar surgery at the First Hospital of Jilin University. The LLSG was selected from outpatients who had underwent lumbar spine computed tomography (CT) and Flexion and extension radiographs (FER) at the First Hospital of Jilin University from 2015 to 2017. Several lower lumbar parameters were measured, including Lordosis angle (LA), intervertebral height (IH), ratio of anterior height to posterior height (APR), angle between endplate and anterior edge of vertebral body (AEPVa), sagittal slip ratio (SSR), and angle between the upper endplate and z-axis on sagittal plane (AUEZS). These parameters were keyed into the SPSS software to create a predictive model for classification. Sensitivity, specificity, predictive accuracy, and Kappa value were used to evaluate the predictive model.
Compared with LLSG, the LA of LLIG decreased by 3.49° (126.54° vs 130.3°). Similarly, the IH of LLIG decreased by 1.23°mm, 1.66°mm, and 0.71°mm at L3-4, L4-5, and L5-S1. Compared with LLSG, the SSR of LLIG is higher at L3-4, L4-5, and L5-S1 (0.54 vs 0.51, 0.57 vs 0.46, and 0.59 vs 0. 47). Moreover, the APR of LLIG is higher than those of LLSG at L3-4, L4-5, and L5-S1 (1.97 vs 1.81, 2.40 vs 1.97, and 2.69 vs 2.26). The LLIG has bigger AEPVa than LLIG at L3-4, L4-5, and L5-S1. Compared with LLSG, the AUEZS of LLIG is bigger at L3-4 (91.75° vs 90.81°) and smaller at L4-5 and L5-S1(84.63° vs 85.85° and 73.27° vs 75.01°). The SSR (L4) show highest predictive accuracy (83%) when every parameter was fed to LDA classifier to generate a univariate model. All parameters represent a statistically significant difference (P < 0.05) between LLSG and LLIG. The model including LA, APR (L5-S1), IH (L4-5), SSR (L5), AUEZS (L5) has highest predictive accuracy of 88.2%. The sensitivity, specificity, and Kappa value are 88.7%, 93.1%, and 0.77.
The predictive model has good classification performance and can be an auxiliary tool for clinicians to evaluate lumbar instability in preoperative patients with severe pain aggravated by lumbar movement.
本研究旨在建立下腰椎失稳的预测模型。
本回顾性研究纳入 199 例患者。将患者分为下腰椎失稳组（LLIG）（n=98）和下腰椎稳定组（LLSG）（n=101）。LLIG 组所有患者均于 2015-2017 年期间因接受腰椎手术而在吉林大学第一医院招募；LLSG 组则选自 2015-2017 年期间在吉林大学第一医院行腰椎 CT 和屈伸位 X 线片检查的门诊患者。测量了多个下腰椎参数，包括腰椎前凸角（LA）、椎间高度（IH）、前高与后高比（APR）、终板前缘与椎体前缘夹角（AEPVa）、矢状面滑移比（SSR）和矢状面上上终板与 Z 轴夹角（AUEZS）。将这些参数输入 SPSS 软件，为分类创建预测模型。使用灵敏度、特异性、预测准确性和 Kappa 值评估预测模型。
与 LLSG 相比，LLIG 的 LA 降低了 3.49°（126.54° vs 130.3°）。同样，LLIG 的 IH 在 L3-4、L4-5 和 L5-S1 处分别降低了 1.23°mm、1.66°mm 和 0.71°mm。与 LLSG 相比，LLIG 的 SSR 在 L3-4、L4-5 和 L5-S1 处较高（0.54 vs 0.51、0.57 vs 0.46 和 0.59 vs 0.47）。此外，LLIG 的 APR 在 L3-4、L4-5 和 L5-S1 处高于 LLSG（1.97 vs 1.81、2.40 vs 1.97 和 2.69 vs 2.26）。LLIG 在 L3-4、L4-5 和 L5-S1 处的 AEPVa 均大于 LLSG。与 LLSG 相比，LLIG 的 AUEZS 在 L3-4 处较大（91.75° vs 90.81°），在 L4-5 和 L5-S1 处较小（84.63° vs 85.85°和 73.27° vs 75.01°）。当将每个参数输入 LDA 分类器生成单变量模型时，SSR（L4）的预测准确性最高（83%）。所有参数在 LLSG 和 LLIG 之间均存在统计学显著差异（P < 0.05）。包括 LA、APR（L5-S1）、IH（L4-5）、SSR（L5）和 AUEZS（L5）在内的模型具有最高的 88.2%预测准确性。灵敏度、特异性和 Kappa 值分别为 88.7%、93.1%和 0.77。
该预测模型具有良好的分类性能，可作为临床医生术前评估严重腰痛加重腰椎运动的患者腰椎不稳定的辅助工具。
