Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China.
Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China.
World Neurosurg. 2024 Mar;183:e603-e612. doi: 10.1016/j.wneu.2023.12.153. Epub 2024 Jan 5.
Posterior single-door laminoplasty is a widely practiced clinical procedure, but the occurrence of postoperative axial syndrome (AS) remains a significant concern. The aim of this study was to identify risk factors associated with AS and develop a risk prediction model.
Clinical data from 226 patients who underwent posterior single-door laminoplasty between June 2017 and June 2022 were collected. Through Logistic model analysis, the risk factors of AS are clarified and the intensity of each risk factor is explained in the form of forest plot. Subsequently, we constructed a predictive model and plotted receiver operating characteristic curves to assess the model's predictive value.
In the end, 87 cases were diagnosed with AS, resulting in an incidence rate of 38.5%. Logistic regression analysis revealed that preoperative encroachment rate of anterior spinal canal (pre-op ERASC), intraoperative facet joints destruction, intraoperative open-door angle, postoperative loss of cervical curvature, and postoperative loss of cervical range of motion were independent risk factors for AS. Conversely, preoperative cervical curvature (pre-op CC) and postoperation early function training were protective factors against AS. The Youden index indicated that the cutoff values for pre-op ERASC and pre-op CC were 26.6°and 16.5, respectively. The risk prediction model for AS was constructed and a nomogram was plotted. The model has high clinical value.
Pre-op ERASC, pre-op CC, intraoperative facet joints destruction, intraoperative open-door angle, postoperative loss of cervical curvature, postoperative loss of cervical range of motion, and postoperation early function training are independent influencing factors for AS occurrence. The risk model has good practicability.
后路单开门椎管扩大成形术是一种广泛应用的临床术式，但术后发生轴性症状（axial syndrome，AS）仍是一个突出的问题。本研究旨在明确与 AS 发生相关的危险因素，并建立风险预测模型。
收集 2017 年 6 月至 2022 年 6 月期间 226 例行后路单开门椎管扩大成形术患者的临床资料。通过 Logistic 模型分析，明确 AS 的危险因素，并以森林图形式阐述各危险因素的强度。随后，构建预测模型并绘制受试者工作特征曲线以评估模型的预测价值。
最终共有 87 例患者诊断为 AS，发生率为 38.5%。Logistic 回归分析显示，术前椎管前缘侵占率（pre-op ERASC）、术中关节突关节破坏、术中开门角度、术后颈椎曲度丢失和术后颈椎活动度丢失是 AS 的独立危险因素。相反，术前颈椎曲度（pre-op CC）和术后早期功能锻炼是 AS 的保护因素。约登指数提示 pre-op ERASC 和 pre-op CC 的截断值分别为 26.6°和 16.5。构建 AS 风险预测模型并绘制列线图，模型具有较高的临床应用价值。
pre-op ERASC、pre-op CC、术中关节突关节破坏、术中开门角度、术后颈椎曲度丢失、术后颈椎活动度丢失和术后早期功能锻炼是 AS 发生的独立影响因素。所构建的风险模型具有较好的实用性。
