Department of Orthopedic Surgery, Peking University First Hospital, Beijing, 100032, People's Republic of China.
Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, People's Republic of China.
Clin Interv Aging. 2021 Sep 29;16:1735-1746. doi: 10.2147/CIA.S330783. eCollection 2021.
This study aimed to assess the risk variables for predicting intra-spinal canal cement leakage, especially among elderly patients with spine metastases after being treated with percutaneous vertebroplasty (PVP). Furthermore, we proposed and validated a nomogram to stratify risks of intra-spinal canal cement leakage.
We retrospectively analyzed 163 elderly patients (age ≧65 years) with spine metastases who underwent PVP. Patients were randomly divided into a training cohort (n=100) and a validation cohort (n=63). The multivariate logistic regression analysis was used to screen potential risk variables in the training cohort. Significant risk variables were included in the nomogram, and the nomogram was developed according to the estimates of the each included variable. The predictive effectiveness of the nomogram was validated using discrimination and calibration performance.
The overall prevalence of intra-spinal canal cement leakage was 9.82% (16/163). In the training cohort, female patients (14.71%, 5/34) showed a higher rate of intra-spinal canal cement leakage as compared with male patients (4.55%, 3/66). The nomogram consisted of sex, cortical osteolytic destruction in posterior wall, and load-bearing lines of spine. The nomogram had acceptable discrimination, with the area under the receiver operating characteristic (AUROC) of 0.75 in the training cohort, 0.64 in the validation cohort, and 0.69 in the entire cohort, and also showed favorable calibration based on the goodness-of-fit test. According to the nomogram, three risk groups were developed: the low risk group had an actual probability of 7.03%, the medium risk group was 11.54%, and high risk group was 44.44%. The difference between the three groups was significant (P ˂ 0.01).
Intra-spinal canal cement leakage after PVP is not scarce among elderly patients. We proposed and internally validated a nomogram that is capable of calculating the risk of intra-spinal canal cement leakage among elderly patients with spine metastases. Careful surgical plan should be conducted among patients with a high risk of developing intra-spinal canal cement leakage.
本研究旨在评估预测经皮椎体成形术（PVP）治疗后脊柱转移瘤老年患者椎管内水泥渗漏的风险变量，特别是针对椎管内水泥渗漏的风险变量。此外，我们提出并验证了一个列线图，以对椎管内水泥渗漏的风险进行分层。
我们回顾性分析了 163 例（年龄≥65 岁）接受 PVP 治疗的脊柱转移瘤老年患者。患者被随机分为训练队列（n=100）和验证队列（n=63）。多变量逻辑回归分析用于筛选训练队列中的潜在风险变量。将显著的风险变量纳入列线图，并根据每个纳入变量的估计值制定列线图。通过判别和校准性能验证列线图的预测效果。
椎管内水泥渗漏的总体发生率为 9.82%（16/163）。在训练队列中，与男性患者（4.55%，3/66）相比，女性患者（14.71%，5/34）椎管内水泥渗漏发生率更高。列线图由性别、后壁皮质溶骨性破坏和脊柱负重线组成。该列线图具有可接受的判别能力，训练队列的受试者工作特征曲线（AUROC）为 0.75，验证队列为 0.64，全队列为 0.69，并且通过拟合优度检验显示出良好的校准。根据列线图，将患者分为低危组（实际概率为 7.03%）、中危组（11.54%）和高危组（44.44%）。三组之间差异有统计学意义（P<0.01）。
PVP 治疗后脊柱转移瘤老年患者椎管内水泥渗漏并不罕见。我们提出并内部验证了一个列线图，能够计算脊柱转移瘤老年患者椎管内水泥渗漏的风险。对于发生椎管内水泥渗漏风险较高的患者，应谨慎制定手术计划。
