Emergency Department, Zigong Fourth People's Hospital, Zigong, China.
Neurology Department, Zigong First People's Hospital, Zigong, China.
Eur Spine J. 2024 Mar;33(3):906-914. doi: 10.1007/s00586-024-08141-9. Epub 2024 Feb 11.
To predict and analyse the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation.
Information of 426 patients treated by early applicated percutaneous endoscopic interlaminar discectomy (PEID) for lumbar disc herniation (LDH) at our hospital from June 2017 to October 2021 in addition to 17 other features was collected. The risk factors were selected by the least absolute shrinkage and selection operator method (LASSO) regression. Then, a prediction model (nomogram) was established to predict the unfavourable outcomes of using the risk factors selected from LASSO regression. Bootstrap (n = 1000) was used to perform the internal validation, and the performance of the model was assessed by the concordance index (C-index), receiver operating characteristic curve, and calibration curve. The decision curve analysis (DCA) and clinical impact curve (CIC) were used to assess the clinical utility of the model, respectively.
Finally, 53 of 426 patients showed unfavourable outcomes. Five potential factors, Modic change, Calcification, Lumbar epidural steroid injection preoperative, Articular process hyperplasia and cohesion, and Laminoplasty technique, were selected according to the LASSO regression, that identified the predictors to establish nomogram model. Meanwhile, the C-index of the prediction nomogram was 0.847, the area under the receiver operating characteristic curve value was 0.847, and the interval bootstrapping (n = 1000) validation C-index was 0.809. The model has good practicability for clinics according to the DCA and CIC.
This nomogram model has good predictive performance and clinical practicability, which could provide a certain basis for predicting unfavourable outcomes of early applicated PEID for LDH.
预测和分析早期应用经皮内镜椎间孔入路椎间盘切除术治疗腰椎间盘突出症的不良结局。
收集我院 2017 年 6 月至 2021 年 10 月采用早期经皮内镜椎间孔入路椎间盘切除术（PEID）治疗的 426 例腰椎间盘突出症患者的资料，共 17 项其他特征。采用最小绝对收缩和选择算子法（LASSO）回归选择危险因素。然后，根据 LASSO 回归选择的危险因素建立预测模型（列线图），以预测使用该模型的不良结局。Bootstrap（n=1000）用于内部验证，通过一致性指数（C-index）、受试者工作特征曲线和校准曲线评估模型性能。分别采用决策曲线分析（DCA）和临床影响曲线（CIC）评估模型的临床实用性。
最终 426 例患者中有 53 例出现不良结局。根据 LASSO 回归，选择了 5 个潜在因素：Modic 改变、钙化、腰椎硬膜外类固醇注射术前、关节突增生和粘连、以及椎板成形术技术，确定了预测因素并建立了列线图模型。同时，预测列线图的 C-index 为 0.847，接受者操作特征曲线下面积值为 0.847，间隔 bootstrap（n=1000）验证 C-index 为 0.809。根据 DCA 和 CIC，该模型在临床上具有良好的实用性。
该列线图模型具有良好的预测性能和临床实用性，可为预测早期应用 PEID 治疗腰椎间盘突出症的不良结局提供一定依据。
